Publications (2)5.73 Total impact
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Article: Electrophysiological Effects of Acute Atrial Stretch on Persistent Atrial Fibrillation in Patients undergoing Open Heart Surgery.
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ABSTRACT: OBJECTIVE: We studied the electrophysiologic effects of acute atrial dedilatation and subsequent dilatation, in patients with long-lasting persistent atrial fibrillation (AF) with structural heart disease undergoing elective cardiac surgery. METHODS: Nine patients were studied. Mean age was 71±10 years, and left ventricular ejection was 46±6%. Patients had at least moderate mitral valve regurgitation and dilated atria. After sternotomy and during extracorporal circulation, mapping was performed on the beating heart with 2 multi-electrode arrays (60 electrodes each, interelectrode distance 1.5 mm) positioned on the lateral wall of the right atrium (RA) and left atrium (LA). Atrial pressure and size were altered by modifying extracorporal circulation. Atrial fibrillation electrograms were recorded at baseline, after dedilation and after dilatation of the atria afterwards. RESULTS: At baseline median, AF cycle length (mAFCL) was 184±27ms in RA and 180±17ms in LA. After dedilatation, mAFCL shortened significantly to 168±13 in RA and to 168±20ms in LA. Dilatation lengthened mAFCL significantly in RA to 189±17ms and in LA to 185±23ms. Conduction block (CB) at baseline was 14.3±3.6% in RA and 17.3±5.5% in LA. CB decreased significantly with dedilatation to 7.4±2.9 in RA and to 7.9±6.3% in LA. CB increased significantly with dilatation afterwards to 15.0±8.3% in RA and to 18.5±16.0% in LA. CONCLUSIONS: Acute dedilatation of the atria in patients with longstanding persistent atrial fibrillation causes a decrease in mAFCL in both atria. Subsequent dilatation increased mAFCL. The amount of CB decreased with dedilatation and increased with dilatation afterwards, in both atria.Heart rhythm: the official journal of the Heart Rhythm Society 11/2012; · 4.56 Impact Factor -
Article: Pulmonary vein isolation to treat paroxysmal atrial fibrillation: conventional versus multi-electrode radiofrequency ablation.
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ABSTRACT: For patients with symptomatic atrial fibrillation (AF), a curvilinear multi-electrode ablation (MEA) catheter has been reported to be successful to achieve pulmonary vein (PV) isolation. However, this approach has not been compared prospectively with conventional PV isolation (CPVI) using a standard circular mapping catheter and 3D electro-anatomic mapping. In this prospective non-randomized study, we compared the efficacy of these two techniques. Of 185 consecutive patients, age 54.6 ± 10.1 years, with symptomatic paroxysmal AF (PAF), 96 patients underwent PV isolation by CPVI and 89 patients underwent MEA to isolate the PVs. CPVI was performed by encircling the left- and right-sided PVs. During MEA, the PV ablation catheter (Medtronic, USA) was used to isolate PVs with duty-cycled radiofrequency energy. The mean procedure time was 171.73 ± 52.87 min for CPVI and 133.25 ± 37.99 min for MEA, respectively (P < 0.001). The mean fluoroscopy time was 31.07 ± 14.97 for CPVI and 30.07 ± 11.45 min for MEA (P = 0.651). At 12 months, 80% of patients who underwent CPVI and 82% of patients who underwent MEA were free of symptomatic PAF off antiarrhythmic drug therapy (P = 0.989). Among the variables of age, gender, duration and frequency of PAF, left ventricular ejection fraction, left atrial size, structural heart disease, and the ablation technique, only an increased left atrial size was an independent predictor of recurrent PAF. Left atrial flutter occurred after CPVI in two patients and after MEA ablation in three patients. In patients undergoing catheter ablation for PAF, MEA and CPVI proved equally efficacious.Journal of Interventional Cardiac Electrophysiology 02/2012; 34(2):143-52. · 1.17 Impact Factor
