(Circulation. 2000;102:1879.)
© 2000 American Heart Association, Inc.
Brief Rapid Communications |
First Human Experience With Pulmonary Vein Isolation Using a Through-the-Balloon Circumferential Ultrasound Ablation System for Recurrent Atrial Fibrillation
From the Cleveland Clinic Foundation, Cleveland, Ohio (A.N., J.S., D.B., R.S., R.W., W.S., L.K., P.T.); Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.P., R.F., D.P., P.S.); and the University of California, San Francisco (M.L.).
Correspondence to Andrea Natale, MD, Director, Electrophysiology Laboratories, The Cleveland Clinic Foundation, Cardiology/F15, 9500 Euclid Avenue, Cleveland, Ohio 44195. E-mail natalea{at}ccf.org
Background—Standard mapping and ablation of focal sources of atrial fibrillation are associated with very long procedure times and low efficacy. An anatomic approach to complete pulmonary vein isolation could overcome these limitations.
Methods and Results—Fifteen patients with atrial fibrillation refractory to medication underwent circumferential isolation of the pulmonary veins by using a novel catheter, with an ultrasound transducer (8-MHz) mounted near the tip, in a saline-filled balloon. Twelve atrial foci and/or atrial fibrillation triggers were identified in 9 patients (pulmonary vein locations: left upper, 3; right upper, 6; right middle, 1; right lower, 1; and left inferior, 1). In 5 patients, lesions were placed in the absence of any mapped triggers. Irrespective of trigger mapping, circumferential isolation of both upper pulmonary veins was attempted in all patients. The lower pulmonary veins were ablated when sinus rhythm activation mapping revealed evidence of a sleeve of atrial muscle in the vein. The median number of lesions per patient required to isolate 1 pulmonary vein was 4 (range, 1 to 29). After ablation, no evidence of narrowing was seen with repeat venography or follow-up computed tomography scan. After a mean follow-up of 35±6 weeks, 5 patients had recurrence of atrial fibrillation. Three responded to drugs that were previously ineffective, and 2 remained in atrial fibrillation.
Conclusions—This novel ultrasound ablation system can successfully isolate multiple pulmonary veins. At early follow-up, this approach seems to be effective in preventing recurrent atrial fibrillation in a significant number of patients.
Key Words: fibrillation • catheters • ultrasonics
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|
|
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|
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|
|
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|
|
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|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 E. B. Saad, N. F. Marrouche, C. P. Saad, E. Ha, D. Bash, R. D. White, J. Rhodes, L. Prieto, D. O. Martin, W. I. Saliba, et al. Pulmonary Vein Stenosis after Catheter Ablation of Atrial Fibrillation: Emergence of a New Clinical Syndrome Ann Intern Med, April 15, 2003; 138(8): 634 - 638. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 S. Verheule, E. E Wilson, R. Arora, S. K Engle, L. R Scott, and J. E Olgin Tissue structure and connexin expression of canine pulmonary veins Cardiovasc Res, September 1, 2002; 55(4): 727 - 738. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
H. Calkins Progress continues in the quest to cure atrial fibrillation with catheter ablation techniques Eur. Heart J., November 2, 2001; 22(22): 2038 - 2040. [PDF]
|
|
|
|
|
|
M. M. Scheinman and F. Morady Nonpharmacological Approaches to Atrial Fibrillation Circulation, April 24, 2001; 103(16): 2120 - 2125. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Oral, B. P. Knight, H. Tada, M. Ozaydin, A. Chugh, S. Hassan, C. Scharf, S. W.K. Lai, R. Greenstein, F. Pelosi Jr, et al. Pulmonary Vein Isolation for Paroxysmal and Persistent Atrial Fibrillation Circulation, March 5, 2002; 105(9): 1077 - 1081. [Abstract] [Full Text] [PDF]
|
|