[Show abstract][Hide abstract] ABSTRACT: Minimally invasive pulmonary vein isolation was developed as a treatment of lone atrial fibrillation. Until recently, electrophysiological studies in patients with recurrent arrhythmias had not been described.
One hundred thirty patients underwent mini-maze pulmonary vein isolation. We performed catheter ablation guided by CARTO mapping in 8 recurrent patients (mean 61.8 + or - 12.7 years old; male:female ratio, 5:3) 5.0 + or - 14 months after the original surgical procedure.
Recurrent atrial fibrillation occurred in 4 patients, atrial tachycardia occurred in 1 patient, and atrial flutter was present in 3 patients. CARTO mapping revealed that in 3 atrial fibrillation patients, gaps in the lesion were present at the roof and the bottom of the pulmonary vein. One of these patients was also found to have microreentry around the base of the left atrial appendage. The fourth recurrent atrial fibrillation patient was found to have a gap in the pulmonary vein isolation ring. One patient with atrial tachycardia was documented to have ectopic focus between the left atrial appendage and left superior pulmonary vein. In the 3 patients with atrial flutter, it was found to be localized to the mitral valve annulus in 2 patients, and to the left atrial roof of the remaining patient. All 8 patients underwent ablation successfully. At the latest follow-up, all patients were free of arrhythmias and independent of antiarrhythmic drugs.
Pulmonary vein conduction at the roof and the bottom of the pulmonary vein after pulmonary vein isolation is the dominant factor responsible for recurrent atrial tachyarrhythmia. Left atrial-related flutter is a common form of arrhythmia.
No preview · Article · Aug 2010 · The Annals of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Minimally invasive surgical pulmonary vein isolation has become an alterative therapy for lone atrial fibrillation. This study evaluated the effect of the procedure on persistent atrial fibrillation by epicardial atrial electrography.
Five consecutive patients with lone persistent atrial fibrillation were enrolled. Intraoperative electrophysiology tests were performed before and after minimally invasive surgical pulmonary vein isolation. Morphology of the recordings and atrial fibrillation cycle length were analyzed.
Sixty sites were recorded in 5 patients. Three types of bipolar electrogram were recorded at these sites. After ablation, all electrograms changed into type I in pulmonary veins and proximal antra, and remained unchanged in all proximal left atria. Atrial fibrillation cycle length at the proximal left atrium was shorter than that at the pulmonary veins. Atrial fibrillation cycle length recorded at proximal left atrium sites correlated with atrial diameter. The atrial fibrillation cycle length of the left atrium increased from 143 +/- 11 to 170 +/- 12 ms after pulmonary vein isolation. All 5 patients had atrial fibrillation immediately after the procedure and were treated with direct-current cardioversion and received amiodarone postoperatively. Freedom from atrial fibrillation was 100% at discharge and 60% at 6 months' follow-up.
Ectopic foci outside the pulmonary veins play an important role in persistent atrial fibrillation. Minimally invasive surgical pulmonary vein isolation might not be sufficient for persistent atrial fibrillation termination. The pulmonary vein isolation procedure, however, slows atrial fibrillation and makes supplemental pharmacologic cardioversion effective.
Full-text · Article · Nov 2008 · The Annals of thoracic surgery