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Ablation of Atrial Fibrillation by Radiofrequency: Circular Energy Delivery

  • T. Lewalter
  • H. Bielik
  • J. Schrickel
  • A. Bitzen
  • J. O. Schwab
  • A. Yang
  • B. Lüderitz
Conference paper

Abstract

Pulmonary vein (PV) ablation has entered the therapeutic armamentarium as a curative intervention in a subset of patients with focal atrial fibrillation (AF)[1]. Clinical application of this therapy is mainly limited by the potentia risks of pericardial tamponade, thromboembolic events, and PV stenosis. The development of PV stenosis has been documented after these procedures, especially when radiofrequency (RF) delivery is performed within the vein and when circumferential burns with multiple applications are necessary [2, 3]. There is evidence that when energy application are limited to the PV ostium or left atrium to the PV transition area, and when patients do not require a full-circumference PV burn, PV stenosis is observed less frequently than with distalintravenous RF delivery [4]. Therefore, identification of a circumscribed left atrial to PV breakthrough during sinus rhythm or atrial pacing may offer the chance of delivering more ‘focal’ RF, rather than a full-circumference RF application. In addition, RF energy delivery should be limited to the PV ostium, which means methods are verifying the position of the ablation catheter are needed

Keywords

Pulmonary Vein Left Atrial Coronary Sinus Catheter Position Radiofrequency Catheter Ablation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Haissaguerre M, Jais P, Shah D, Takahashi A, Hocini M, Quiniou G, Garrigue S et al (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666PubMedCrossRefGoogle Scholar
  2. 2.
    Yu WC, Hsu TL, Tai CT, Tsai CF, Hsieh MH, Lin WS, Lin YK et al (2001) Acquired pulmonary vein stenosis after radiofrequency catheter ablation of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 12:887–892PubMedCrossRefGoogle Scholar
  3. 3.
    Gerstenfeld EP, Guerra P, Sparks PB, Hattori K, Lesh MD (2001) Clinical outcome after radiofrequency catheter ablation of focal atrial fibrillation triggers, f Cardiovasc Electrophysiol 12:900–908CrossRefGoogle Scholar
  4. 4.
    Haissaguerre M, Shah D, Jais P, Hocini M, Yamane T, Deisenhofer I, Chauvin M et al (2000) Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation 102:2463–2465PubMedCrossRefGoogle Scholar
  5. 5.
    Lewalter T, Burkhardt D, Chun S, Schimpf R, Bielik H, Schrickel J, Shlevkov N, Yang A, Lüderitz B (2002) Decremental intravenous pulse propagation during extrastimulus pacing: relevance for catheter ablation of focal atrial fibrillation. Europace 4:411–415PubMedCrossRefGoogle Scholar
  6. 6.
    Burkhardt D, Schimpf R, Bielik H, Schrickel J, Shlevkov N, Yang A, Schwab JO, Lüderitz B, Lewalter T (2002) Decremental pulmonary vein conduction: relevance for ablation in focal atrial fibrillation. Pacing Clin Electrophysiol 25/4:abs 727Google Scholar
  7. 7.
    Lewalter T, Burkhardt D, Bielik H, Schrickel J, Yang A, Shlevkov N, Schimpf R, Schwab JO, Lüderitz B (2002) Circumferential pulmonary vein mapping and ablation in focal atrial fibrillation: single catheter technique. J Interv Card Electrophysiol 7:165–170PubMedCrossRefGoogle Scholar
  8. 8.
    Hocini M, Shah DC, Jais P, Haissaguerre M, Peng JT, Yamane T, Deisenhofer I et al (2000) Concealed left pulmonary vein potentials unmasked by left atrial stimulation. Pacing Clin Electrophysiol 23:1832–1835PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • T. Lewalter
    • 1
  • H. Bielik
    • 1
  • J. Schrickel
    • 1
  • A. Bitzen
    • 1
  • J. O. Schwab
    • 1
  • A. Yang
    • 1
  • B. Lüderitz
    • 1
  1. 1.Department of Medicine-CardiologyUniversity of BonnGermany

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