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Journal of Cardiovascular... Sep 2021
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Pulmonary Veins
PubMed: 34270156
DOI: 10.1111/jce.15176 -
Journal of Cardiovascular... Jul 2020In patients with persistent atrial fibrillation (AF) despite durable pulmonary vein isolation, there are a variety of approaches to further ablation. Here we summarize... (Review)
Review
In patients with persistent atrial fibrillation (AF) despite durable pulmonary vein isolation, there are a variety of approaches to further ablation. Here we summarize our strategy in this population. In brief, our approach is to isolate the posterior wall, ablate the coronary sinus musculature and left lateral ridge, complete a lateral mitral line, and achieve cavotricuspid isthmus block. Subsequently, we target organized atrial flutters and if AF persists, we ablate areas of long, fractionated electrograms within scarred regions. We administer isuprel in patients with a presentation consistent with triggered atrial fibrillation (low scar burden, paroxysms of AF).
Topics: Atrial Fibrillation; Catheter Ablation; Electrophysiologic Techniques, Cardiac; Humans; Pulmonary Veins; Treatment Outcome
PubMed: 31578754
DOI: 10.1111/jce.14204 -
Pulmonary vein stenosis after HotBalloon pulmonary vein isolation of paroxysmal atrial fibrillation.Heart and Vessels Nov 2021HotBalloon-based pulmonary vein isolation (HBPVI) has yielded encouraging clinical results in the treatment of paroxysmal atrial fibrillation (PAF). However, pulmonary...
HotBalloon-based pulmonary vein isolation (HBPVI) has yielded encouraging clinical results in the treatment of paroxysmal atrial fibrillation (PAF). However, pulmonary vein (PV) stenosis remains a concern. The influence of longer application duration on PV stenosis has not yet been systematically evaluated. All patients who underwent first HBPVI of PAF with pre- and post-ablation computed tomography (CT) were included. We used single-shot technique with application duration of 180 s in the RSPV, 180-240 s in the LSPV, and 120 s in the lower PV procedures. PV stenosis was analyzed using CT and categorized as moderate (50-70%), and severe (> 70%) reduction in PV diameter. We analyzed imaging of the PV anatomy before ablation and during follow-up in 84 patients. Among them, 7 (8.3%) showed moderate stenosis, and 3 (3.6%) had severe stenosis including one total occlusion patient. All severe stenosis and total occlusion occurred in RSPV and LSPV procedures with longer application duration. No severe stenosis nor total PV occlusion occurred in inferior PV procedures with shorter application duration. The incidence of PV stenosis ≥ 50% or total PV occlusion was significantly lower in inferior PV than RSPV and LSPV procedures (0.6%, 6.0%, 8.0%, p = 0.01, respectively). All cases of PV stenosis including total PV occlusion patients were asymptomatic. No intervention for PV stenosis was performed. The risk of PV stenosis in HBPVI was rare in lower PV procedure with shorter application duration. An application duration setting of 120 s in lower PV procedure might be effective to prevent PV stenosis.
Topics: Atrial Fibrillation; Catheter Ablation; Constriction, Pathologic; Humans; Pulmonary Veins; Stenosis, Pulmonary Vein; Treatment Outcome
PubMed: 33929574
DOI: 10.1007/s00380-021-01862-7 -
Pacing and Clinical Electrophysiology :... Jul 2003The basic electrophysiologic studies have proved the arrhythmogenic mechanisms of the pulmonary vein as an atrial fibrillation initiator; the mechanisms include enhanced... (Review)
Review
The basic electrophysiologic studies have proved the arrhythmogenic mechanisms of the pulmonary vein as an atrial fibrillation initiator; the mechanisms include enhanced automaticity, triggered activity, and microreentry from myocardial sleeves inside pulmonary veins. Immunohistology study has proved the conduction characteristics of pulmonary vein myocardium, and further study of ionic currents are important for understanding atrial fibrillation initiation from the pulmonary vein.
Topics: Animals; Atrial Fibrillation; Cardiac Pacing, Artificial; Cardiovascular Agents; Heart Rate; Humans; Ion Channels; Pulmonary Veins; Vagus Nerve
PubMed: 12914606
DOI: 10.1046/j.1460-9592.2003.t01-1-00235.x -
Biological & Pharmaceutical Bulletin 2013The pulmonary vein contains a myocardial layer extending from the left atrium, which is receiving attention as the source of ectopic electrical activity underlying... (Review)
Review
The pulmonary vein contains a myocardial layer extending from the left atrium, which is receiving attention as the source of ectopic electrical activity underlying atrial fibrillation. Electrophysiological and pharmacological analysis of the pulmonary vein myocardium performed in various experimental animal species have revealed characteristics such as presence of intracellular Ca(2+) oscillations and low repolarizing potency. The automaticity of the pulmonary vein myocardium is affected by various neurotransmitters, hormones and pharmacological agents. Clarification of the mechanisms and regulation of pulmonary vein automaticity would lead to the development of novel therapeutic strategies and pharmacological agents for atrial fibrillation.
Topics: Action Potentials; Animals; Calcium; Myocardium; Pulmonary Veins
PubMed: 23302630
DOI: 10.1248/bpb.b212020 -
Journal of Interventional Cardiac... Jun 2021Progress of balloon devices for pulmonary vein (PV) isolation in atrial fibrillation (AF) has been remarkable. However, these techniques were specialized in pulmonary...
PURPOSE
Progress of balloon devices for pulmonary vein (PV) isolation in atrial fibrillation (AF) has been remarkable. However, these techniques were specialized in pulmonary vein treatment; predicting non-PV foci in advance is important to decide the treatment strategy. In this study, we investigate the predictors for paroxysmal AF.
METHODS
Subjects were consecutive paroxysmal AF patients who underwent high-dose isoproterenol provocation after PV isolation in the first session. The PV group (n = 102) and non-PV group (n = 222) were defined as the patients with and without non-PV ablation, respectively. Non-PV ablation was performed when frequent repetitive premature atrial contractions or triggered AF occurred spontaneously or by isoproterenol provocation. Predictors of non-PV origin in paroxysmal AF patients were examined using clinical characteristics and preoperative echocardiography.
RESULTS
In the multivariate logistic regression analysis, female sex, body mass index (BMI < 23.8), absence of hypertension, and higher ratio of mitral early diastolic peak (E-wave) to early diastolic mitral annulus peak (e') velocity (E/e' > 8.44) were significant independent predictors of non-PV foci (hazard ratio 2.04, 1.88, 3.63, and 2.33; 95% confidence interval 1.17-3.55, 1.05-3.39, 1.72-7.67, and 1.34-4.05; p = 0.011, 0.035, < 0.001, and 0.003, respectively). If a patient had these four factors, non-PV was detected with 96.8% specificity.
CONCLUSION
Female sex, lower BMI, absence of hypertension, and higher E/e' were significant indicators of non-PV foci in patients with paroxysmal AF. Reviewing these factors in advance may be useful for selecting a device to perform pulmonary vein isolation.
Topics: Atrial Fibrillation; Catheter Ablation; Female; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 32468323
DOI: 10.1007/s10840-020-00779-x -
The Journal of Thoracic and... Jul 2015
Topics: Female; Humans; Male; Pulmonary Veins
PubMed: 26126465
DOI: 10.1016/j.jtcvs.2015.05.020 -
The Journal of Invasive Cardiology May 2020A 43-year-old woman underwent radiofrequency pulmonary vein ablation for symptomatic paroxysmal atrial fibrillation. At 3 months, she developed worsening dyspnea and...
A 43-year-old woman underwent radiofrequency pulmonary vein ablation for symptomatic paroxysmal atrial fibrillation. At 3 months, she developed worsening dyspnea and exercise intolerance; tests revealed severe stenosis in her right pulmonary veins at the venoatrial junction and an abnormally small left atrium.
Topics: Adult; Angiography; Atrial Fibrillation; Catheter Ablation; Female; Humans; Pulmonary Veins; Stenosis, Pulmonary Vein
PubMed: 32357141
DOI: No ID Found -
Journal of Cardiothoracic and Vascular... Feb 2013
Review
Topics: Cardiovascular Diseases; Echocardiography, Transesophageal; Humans; Monitoring, Intraoperative; Pulmonary Veins
PubMed: 22863405
DOI: 10.1053/j.jvca.2012.06.019 -
Asian Cardiovascular & Thoracic Annals Jun 2022
Topics: Bronchi; Humans; Lung Diseases; Pulmonary Veins; Treatment Outcome; Vascular Malformations
PubMed: 35437026
DOI: 10.1177/02184923221095726