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(Circulation. 2000;101:1274.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Pulmonary Vein Morphology in Patients With Paroxysmal Atrial Fibrillation Initiated by Ectopic Beats Originating From the Pulmonary Veins
Implications for Catheter Ablation
From the Division of Cardiology, Department of Medicine, National Yang-Ming University School of Medicine and Veterans General Hospital-Taipei (V.S.P., C.-T.T., W.-C.Y., Y.-K.L., Y.-A.D., M.-S.C., S.-A.C.); the Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital (W.-S.L.); the Division of Cardiology, Department of Internal Medicine, Chung Shan Medical and Dental College, Taichung (C.-F.T.); and the Division of Cardiovascular Medicine, Taipei Medical College and Taipei Wan-fang Hospital (M.-H.H.), Taipei, Taiwan.
Correspondence to Shih-Ann Chen, MD, Division of Cardiology, Veterans General Hospital-Taipei, 201, Sec 2, Shih-Pai Road, Taipei, Taiwan, ROC. E-mail sachen{at}vghtpe.gov.tw
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Abstract |
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 Top Abstract IntroductionMethodsResultsDiscussionReferences |
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Background—Successful ablation of ectopic beats originating from the pulmonary veins (PV) could eliminate paroxysmal atrial fibrillation (PAF). However, information about the structure of the PV in patients with PAF that is initiated by PV ectopic beats has not been reported.
Methods and Results—We studied the morphology of the PVs and measured their diameters in 3 groups of patients. Group I included 52 patients (aged 66±14 years; 44 men) with focal atrial fibrillation (AF) from the PVs. Group II included 8 patients (aged 50±10 years; 3 men) with focal AF from the superior vena cava or cristal terminalis. Group III included 23 control patients (aged 55±16 years; 17 men). Of the control patients, 11 had AV node and 12 had AV reentrant tachycardia. After an atrial transseptal procedure, selective PV angiography using a biplane system with a right anterior oblique view of 30 degrees, a left anterior oblique view of 60 degrees, and a cranial angle of 20 degrees was performed. The ostial and proximal portions of the right and left superior PVs (RSPV and LSPV) were significantly dilated in group I patients compared with those in groups II and III. Furthermore, the ostia of the RSPV and LSPV were significantly dilated in group II compared with group III patients. However, the mean diameters of the inferior PVs were similar between the 3 groups. Comparisons of the individual PV diameters among the 3 subgroups of group I (which was divided according to where the ectopic focus was located) showed nonselective dilatation of the PV.
Conclusions—Nonspecific dilatation of the ostia and proximal portion of superior PVs were found in patients with PAF initiated by ectopic beats from the superior PVs.
Key Words: fibrillation • veins • ablation
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Introduction |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
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Atrial fibrillation (AF) is one of the most frequently encountered arrhythmias in the clinical setting. Jais et al1 and Haissaguerre et al2 first documented that paroxysmal AF (PAF) could be initiated by ectopic beats from the pulmonary veins (PVs) and that successful ablation of these ectopic beats could eliminate PAF. This laboratory also demonstrated similar findings.3 4 However, a lack of information about the structure of the PVs still exists.
Precise mapping of the electrical activities along the PVs requires proper delineation of PV structure, especially the atriopulmonary junction and the tributaries of the PVs. Furthermore, the design of new devices, such as an ablation balloon for circumferential isolation of the PV, requires careful evaluation of proximal PV structure and diameter.
The purposes of this study were to (1) study the structural differences of the PV between PAF patients and controls and (2) demonstrate the impact of PV structure on the ectopic beats that initiate AF and, thus, catheter ablation.
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Methods |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
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Patient Characteristics
Patients were divided into 3 groups. Group I consisted of 52 patients (44 men and 8 women with a mean age of 66±14 years and an age range of 27 to 86 years) who had frequent attacks (mean, 5±2 episodes/day) of PAF initiated by atrial premature beats that were documented by 24-hour Holter monitoring. These patients were refractory to 3±1 antiarrhythmic drugs, and the electrophysiologic study and radiofrequency catheter ablation proved that the PAF originated from the PVs. Group II was composed of 8 patients (3 men and 5 women with a mean age of 50±10 years and an age range of 36 to 69 years) who had PAF; the electrophysiologic study and radiofrequency catheter ablation proved the PAF originated from the superior vena cava (SVC) or cristal terminalis. Group III was made up of 23 control subjects (17 men and 6 women with a mean age of 55±16 years and an age range of 36 to 69 years) who had AV node reentrant tachycardia (11 patients) or AV reciprocating tachycardia mediated by a concealed accessory pathway (12 patients) and who did not have documented or inducible AF. All patients gave informed consent. All antiarrhythmic drugs except amiodarone were discontinued for
5 half-lives before the study (Table 1
).
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Selective PV Angiography
The details of PV angiography have been described
previously.3 4 After the standard transseptal procedure,
an initial intravenous bolus dose of 3000 IU of heparin was
given; repeated doses of heparin were given to maintain the
activated clotting time at >300 seconds. Then, 2 sheaths,
8.5-Fr SL1 and 8-Fr SR0 (Daig Co), were introduced into the left atrium
(LA) in each patient. The long sheath (SL1) was used to approach the
right PV, and the short sheath (SR0) was used to cannulate the left PV.
A simple clockwise torque with the sheath pointing posteriorly and to
the right of the spine facilitated entry into the right PV; however, a
slight counterclockwise torque, again with the sheath directed
posteriorly but pointing to the left of the spine, aided access to the
left PV. All patients underwent selective PV angiography using a
NIH or A2 multipurpose angiocatheter (Cordis) introduced through
the long sheath under a biplane fluoroscopic system with a right
anterior oblique view of 30 degrees, a left anterior oblique view of 60
degrees, and a cranial angle of 20 degrees.
The PV ostium was defined as the junction of the PV with the LA. The diameter of the PV ostium was measured in each of the 2 projections (left and right anterior oblique views), and the mean value was obtained. Similar measurements were made 5, 10, 15, 20, 25, and 30 mm inside the PVs; the locations of the venous tributaries were also determined. All measurements were corrected for the degree of magnification of the angiographic image by relating the diameter of the long sheath in each projection to its true diameter. Measurements were made in the still frame that best showed the PV ostium. The diameter of PV ostium was the distance between 2 points: 1 point was the junction between the upper wall of the PV and the wall of the LA, and the other point was the junction between the lower wall of the PV and the wall of the LA. While measurements were made, the patients were in sinus rhythm; the mean heart rates in the 3 groups were 70±10, 66±10, and 68±9 beats/min (P>0.05), respectively.
Pulmonary venous flow is phasic: the first phase of flow occurs during ventricular systole and the second phase of flow during ventricular diastole; it reaches a maximum at the beginning of atrial contraction. At this point, reversed flow occurs.5 To minimize the variations in the diameter of the PVs that occur because of this phasic flow, all measurements were made at the end of ventricular systole. Furthermore, PV diameters were rechecked by 2 cardiologists who were not aware of the diagnosis.
Electrophysiological Study and Radiofrequency
Catheter Ablation
The electrophysiological study and catheter ablation were
performed after selective PV angiography. The details of the techniques
have been described previously.3 4
Catheter Positions
Two multipolar, closely spaced (interelectrode space, 2 mm;
distance between each bipolar pair, 5 mm) electrode catheters with
a deflectable tip (Mansfield Division, Boston Scientific Inc) were
introduced from the right and left femoral veins and placed in the
anterolateral high right atrium and the His bundle area for
recording and pacing. A 7-Fr, deflectable, decapolar catheter
(Daig Co), which had a 2-mm interelectrode distance within each pair
and 5 mm of space between each electrode pair, was also inserted
into the coronary sinus via the internal jugular vein. Two
6-Fr, deflectable, decapolar catheters (same electrode spacing as
coronary sinus catheter) were put into the superior PVs (or
inferior PVs if the P wave of the ectopic beat initiating
the AF was not positive in the inferior leads) through the
2 long transseptal sheaths, with the first pair of electrodes
straddling the ostium of the PVs. For patients with a possibility of
right atrial ectopic foci, one duodecapolar catheter (1–2-1 mm
spacing, Daig Co) was put in the SVC and one Crista catheter
(Cordis-Webster Co) was put along the cristal terminalis for detailed
mapping.
Electrophysiologic Study
A programmed digital stimulator (DTU-210 or 215, Bloom Associate
Ltd) was used to deliver electrical impulses of 2.0 ms for a interval
of twice the diastolic threshold. Intracardiac bipolar
electrograms (filter was set from 30 to 500 Hz) were displayed
simultaneously with ECG leads V1, I, and II on a
multichannel recorder (CardioLab System, Prucka Engineering, Inc),
and were recorded on paper at a speed of 100 or 200 mm/s. The
methods used to provoke spontaneous AF are standardized in our
laboratory.3 4
Radiofrequency Ablation
The presumed ablation site was chosen on the basis of the
earliest bipolar activity and/or a local unipolar QS pattern of the
ectopic beats that initiated AF. Among the patients with 2 ectopic
foci initiating AF, the ectopic foci were sequentially ablated. The
protocols used to provoke spontaneous AF before ablation were repeated
to confirm the procedural success.3 4
Statistical Analysis
Quantitative data are expressed as mean±SD, and they were
compared using unpaired t tests. P<0.05 was
considered significant. One-way ANOVA was used to analyze the
differences among the 3 groups.
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Results |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
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PV Diameters
Right and Left Superior PVs
The mean ostial diameters of the right and left superior PVs (RSPV and LSPV) in group I patients were significantly greater than those in the other 2 groups (Figures 1 through 3
). At
distances of 5, 10, and 15 mm inside the ostium, the mean
diameters of group I patients were still greater than those in control
patients. However, the mean diameters of group I patients were similar
to those of group II patients and control patients at distances of 20,
25, and 30 mm from the ostium. This proximal dilatation was seen
consistently in the left and right anterior oblique view
projections. Furthermore, the ratio of superior PV ostium diameter
to LA size was similar between the 3 groups (Table 2).
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Right and Left Inferior PVs
As shown in Table 3 and Figure 1D
, only the mean diameter of the right inferior PV
ostium was greater in group I patients; at all other sites, the
diameters of the inferior PVs in group I and group III
patients were similar to those in controls.
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Branching Pattern of Proximal PV
In group I, the first PV branch occurred within the first 10
mm in 14 patients (26.9%); in 10 patients (19.2%), it occurred 10 to
20 mm inside the PV ostia. In group II, 1 patient (12.5%) had the
first branch within the first 10 mm, and 2 patients (25%) had it
10 to 20 mm inside the PV ostia. Of the control population, 3
subjects (13%) demonstrated an early vessel within the first 10
mm, and 4 subjects (17.4%) had the branch 10 to 20 mm inside the
PV ostia.
Relationship Between the Ectopic Foci Initiating AF and the
Dilatation of the PVs
Group I patients were further divided into 3 subgroups on the
basis of the location of the ectopic foci. In group IA, the ectopic
focus was in the LSPV only (20 patients; mean age, 64±12 years; 17
men); in group IB, the ectopic focus was in the RSPV only (15 patients;
mean age, 66±17 years; 11 men); and in group IC, the ectopic foci were
from both the RSPV and LSPV (17 patients; mean age, 67±14 years; 16
men). These ectopic foci initiated spontaneous AF, and they were
eliminated after successful ablation. The results of comparing the
individual PV diameters among the subgroups (IA, IB, and IC) showed a
nonselective dilatation of the PVs (Table 2). Furthermore, the
dilatation of the PV ostia showed a positive relation between RSPV and
LSPV (Figure 4). The sites with
successful ablation of the ectopic foci were further divided into
proximal or distal lesions (<20 mm or 20 mm inside the PV,
respectively); the diameters of proximal or distal lesions were not
related to the ectopic foci of AF. Group II patients had ectopic
foci in the SVC (n=5) or the upper portion of the cristal terminalis
(n=3).
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Relationship Between PV Diameters and Other Parameters
In all 3 groups, no pressure gradient existed between the proximal
PVs and LA pressure. The diameters of the superior PVs were not related
to LA size (Figure 5), LA pressure
(<12 mm Hg: RSPV ostium diameter [O]=13.6±1.6 mm,
LSPV-O=13.8±1.4 mm; 12 mm Hg: RSPV-O= 13.6±1.4 mm,
LSPV-O=13.9±1.3 mm), historical duration of PAF (<2 years:
RSPV-O=13.4±1.7 mm, LSPV-O=13.9±1.7 mm; 2 years:
RSPV-O=13.7±1.4 mm, LSPV-O=13.7±1.3 mm), or the presence of
other structural heart diseases (with heart disease:
RSPV-O=13.4±1.6 mm, LSPV-O=13.6±1.6 mm; without heart
disease: RSPV-O=13.6±1.4 mm, LSPV-O=13.9±1.3 mm). The
diameters of the RSPVs were not related to the patient’s age
(r=0.21, P=0.13), body weight (r=0.16,
P=0.26), height (r=-0.05, P=0.73), or
body mass index (r=0.18, P=0.19). The diameters
of the LSPVs were also not related to the patient’s age
(r=0.2, P=0.15), body weight (r=0.02,
P=0.92), height (r=-0.21, P=0.13), or
body mass index (r=0.14,
P=0.98).
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Discussion |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
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Major Findings
This is the first study that measures the size of the PVs and relates it to arrhythmia. We showed that the patients who had PAF that was initiated by ectopic beats from the superior PVs had greater superior PV diameters than did either control subjects or the patients who had PAF that originated from the SVC or cristal terminalis. However, the dilatation of the PV was not related to the site of the ectopic beats that initiated PAF.
Relation Between PV Diameter/Structure and AF
In the present study, we found that the superior PVs were
significantly dilated and that most of the ectopic beats initiating PAF
originated from the superior PVs. However, site-specific dilatation of
the PVs was not evident. Furthermore, the similar ratios of PV ostium
diameter to LA size between the 3 groups suggests
simultaneous dilatation of the PVs and LA. However, the
nonlinear relationship between PV diameter and LA size suggests that
the extent of the dilation of the LA and PV ostia was different; this
may be due to the different compliance of the PV vascular wall and LA
wall among individuals. Thus, some patients had a greater dilatation of
the PVs and less enlargement of the LA, whereas others had greater
enlargement of the LA and less dilatation of the PVs.
The proximal portion of the PV has a sleeve of myocardium that is a direct extension from the adjacent atrial tissue and that is electrically coupled to the atrium.6 The electrical activity in the PVs was presumed to be a result of this cardiac musculature because the smooth muscles were noted to be electrically quiescent.7 It is possible that disorganized contraction of the muscle sphincters at the atriopulmonary venous junction as a result of rapid and chaotic firing of the ectopic focus in addition to the delayed changes of structure similar to the LA may account for an increase in the dimensions of the atriopulmonary venous junction.
Dilatation of PVs in patients with PAF caused by the PVs may stretch the proximal portion of the PVs to a greater degree than in control patients; thus, the ectopic beats might be initiated by the stretch mechanism. Previous studies have demonstrated that increased stretch may modify the electrophysiological characteristics of cardiac tissue and induce triggered activity resulting in arrhythmia.8 9 In the patients with PAF originating from the SVC/cristal terminalis, PV dilatation was also demonstrated. It is possible that these patients may have ectopic beats from PVs in the late follow-up period. Although the dilatation of PV diameters did not show a site-specific relationship, the possibility of pathological changes in the PVs may explain the spontaneous onset of ectopic beats from the PVs. Previous studies also showed significant dilatation of the coronary sinus ostium in patients with AV nodal reentrant tachycardia and speculated that the tissue around the ostium was closely related to the slow pathways in patients with this disease.10 Furthermore, diverticulum in the proximal portion of the coronary sinus was also demonstrated to be related to the accessory pathway in the posteroseptal space.11 12
Implications for Catheter Ablation
The assessment of PV anatomy and the measurement of PV
diameters during the venophase of pulmonary
arterial angiography has several shortcomings; for example,
the margins of the PVs were not accurately delineated, and the
inferior PVs were often overlapped by several structures,
resulting in inadequate visualization.13 14 Thus,
selective PV angiography following a transseptal procedure would be
better to delineate PV structure and to guide accurate mapping along
the PVs. Therefore, we selectively cannulated individual PVs.
The most commonly used method of radiofrequency ablation of ectopic beats from the PVs is the application of energy to the source or exit site of the ectopic beats. However, a risk of PV stenosis with subsequent pulmonary hypertension has been reported with this method.15 16 The new device for circumferential balloon isolation of the PV ostium using radiofrequency or ultrasound energy blocks the conduction between the PVs and LA and prevents AF initiated by ectopic beats from the PVs. Thus, the diameters of the PVs become very important for selecting the optimal size of the balloon for the ablation of the PVs. Furthermore, the diameters of the PVs would be very important in the follow-up study to determine stenosis. For this reason, strict adherence to limited sites of application assigned to the region for successful ablation may result in a lower risk of PV stenosis.
Study Limitations
This study had several limitations. (1) It did not include
patients who had PAF that was initiated by ectopic beats from the
inferior PVs. However, the incidence of ectopic beats from
inferior PVs is very low.2 3 Thus, dilatation
of the right inferior PV ostium in patients with PAF from
superior PVs needs further study. (2) Because PV angiography is an
invasive procedure and the group II patients had definite foci in the
right atrium, inferior PV angiography was not routinely
performed in these patients. (3) We did not routinely perform PV
angiography at follow-up; thus, we did not determine whether PV
diameters decreased after long-term sinus rhythm (without the
occurrence of PAF after radiofrequency ablation). (4) Only 4
patients underwent additional procedures for recurrent PAF, and their
PV angiographic assessment did not show any significant narrowing or
stenosis. However, our routine follow-up
transesophageal echocardiographic
examination found 
40% of patients had an increase of PV flow
velocity after the ablation of PV lesions, but none of these patients
had significant stenosis of the PV.16 (5) Ways to
measure the diameter of the PV ostium still need further investigation
to improve accuracy. However, we usually injected contrast media in the
distal PVs, proximal PVs, and the PV branches to see the details of the
PV trunk, PV branches, and the junction of the PV and LA; thus, we
could clearly identify the PV ostium.
Conclusions
Nonspecific dilatation of superior PVs occurred in patients
who had PAF that was initiated by ectopic beats from superior PVs. The
structure and diameters of the proximal portions of the superior PVs
were different between PAF and control patients.
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Acknowledgments |
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Supported in part by grants from the National Science Council (NSC 88-2314-B-010-094, 88-2314-B-010-093) and Tzou 146s Medical Foundation (VTY88-P5-45; VGH-23, 47, 61, 65, 254, and 301), Taipei, Taiwan, Republic of China.
Received July 30, 1999; revision received September 17, 1999; accepted October 11, 1999.
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References |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
1. Jais P, Haissaguerre M, Shah DC, Chouairi S, Gencel L, Hocini M, Clementy J. A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation. 1997;95:572–576.
2.
Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini
M, Quiniou G, Garrigue S, Mouroux AL, Metayer PL, Clementy J.
Spontaneous initiation of atrial fibrillation by ectopic beats
originating in the pulmonary veins. N Engl J
Med. 1998;339:659–666.
3. Hsieh MH, Chen SA, Tai CT, Tsai CF, Prakash VS, Yu WC, Liu CC, Ding YA, Chang MS. Double multielectrode mapping catheters facilitate radiofrequency catheter ablation of focal atrial fibrillation originating from pulmonary veins. J Cardiovasc Electrophysiol. 1999;10:136–144.[Medline] [Order article via Infotrieve]
4. Chen SA, Tai CT, Yu WC, Chen YJ, Tsai CF, Hsieh MH, Chen CC, Prakash VS, Ding YA, Chang MS. Right atrial focal atrial fibrillation: electrophysiologic characteristics and radiofrequency catheter ablation. J Cardiovasc Electrophysiol. 1999;10:328–335.[Medline] [Order article via Infotrieve]
5. Rajagopalan B, Bertram CD, Stallard T, Lee GD. Blood flow in pulmonary veins, III: simultaneous measurements of their dimensions, intravascular pressure, and flow. Cardiovasc Res. 1979;13:684–692.[Medline] [Order article via Infotrieve]
6.
Nathan H, Eliakim M. The junction between the left
atrium and the pulmonary veins: an anatomic study of human
hearts. Circulation. 1966;34:412–422.
7.
Cheung DW. Electrical activity of the
pulmonary vein and its interaction with the right atrium in the
guinea-pig. J Physiol. 1980;314:445–456.
8. Satoh T, Zipes DP. Unequal atrial stretch in dogs increases dispersion of refractoriness conductive to developing atrial fibrillation. J Cardiovasc Electrophysiol. 1996;7:833–842.[Medline] [Order article via Infotrieve]
9.
Chen YJ, Chen SA, Tai CT, Wen ZC, Feng AN, Ding YA,
Chang MS. Role of atrial electrophysiology and autonomic nervous system
in patients with supraventricular tachycardia
and paroxysmal atrial fibrillation. J Am Coll Cardiol. 1998;32:732–738.
10.
Doig JC, Saito J, Harris L, Doconar E. Coronary
sinus morphology in patients with atrioventricular
junctional reentry tachycardia and other
supraventricular tachyarrhythmias.
Circulation.. 1995;92:436–441.
11. Arruda MS, McClelland JH, Wang X, Beckman KJ, Widuran LE, Gonzalez MD, Nakagawa H, Lazzara R, Jackman WM. Development and validation of an ECG algorithm for identifying accessory pathway ablation site in Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol. 1998;9:2–12.[Medline] [Order article via Infotrieve]
12. Lesh MD, Van Hare Kao AK, Scheinman UM. Radiofrequency catheter ablation for Wolff-Parkinson-White syndrome associated with a coronary sinus diverticulum. Pacing Clin Electrophysiol. 1991;14:1479–1484.[Medline] [Order article via Infotrieve]
13. Sairanen H, Louhimo I, Tolppanen EM. Pulmonary vein diameter in normal children. Pediatr Cardiol. 1986;6:259–261.[Medline] [Order article via Infotrieve]
14. Robida A. Diameters of pulmonary veins in normal children: an angiocardiographic study. Cardiovasc Intervent Radiol. 1990;12:307–309.
15.
Robbins IM, Colvin EV, Doyle TP, Kemp WE, Loyd JE,
McMahon WS, Kay GN. Pulmonary vein stenosis after
catheter ablation of atrial fibrillation. Circulation. 1998;98:1769–1775.
16.
Chen SA, Hsieh MH, Tai CT, Tsai CF, Prakash VS, Yu WC,
Hsu TL, Ding YA, Chang MS. Initiation of atrial fibrillation by ectopic
beats originating from the pulmonary veins: electrophysiologic
characteristics, pharmacologic responses, and effects of radiofrequency
ablation. Circulation.. 1999;100:1879–1886.
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 C K Silversides, S C Siu, P R McLaughlin, K L Haberer, G D Webb, L Benson, and L Harris Symptomatic atrial arrhythmias and transcatheter closure of atrial septal defects in adult patients Heart, October 1, 2004; 90(10): 1194 - 1198. [Abstract] [Full Text] [PDF]
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 B. Ghaye, D. Szapiro, J.-N. Dacher, L.-M. Rodriguez, C. Timmermans, D. Devillers, and R. F. Dondelinger Percutaneous Ablation for Atrial Fibrillation: The Role of Cross-sectional Imaging RadioGraphics, October 1, 2003; 23(90001): S19 - 33. [Abstract] [Full Text] [PDF]
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J. M. Lacomis, W. Wigginton, C. Fuhrman, D. Schwartzman, D. R. Armfield, and K. M. Pealer Multi-Detector Row CT of the Left Atrium and Pulmonary Veins before Radio-frequency Catheter Ablation for Atrial Fibrillation RadioGraphics, October 1, 2003; 23(90001): S35 - 48. [Abstract] [Full Text] [PDF]
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R. J. Hassink, H. T. Aretz, J. Ruskin, and D. Keane Morphology of atrial myocardium in human pulmonary veins: A postmortem analysis in patients with and without atrial fibrillation J. Am. Coll. Cardiol., September 17, 2003; 42(6): 1108 - 1114. [Abstract] [Full Text] [PDF]
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A. M. Qureshi, L. R. Prieto, L. A. Latson, G. K. Lane, C. I. Mesia, P. Radvansky, R. D. White, N. F. Marrouche, E. B. Saad, D. L. Bash, et al. Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation Circulation, September 16, 2003; 108(11): 1336 - 1342. [Abstract] [Full Text] [PDF]
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 P. Jais, D.C. Shah, M. Hocini, L. Macle, K.-J. Choi, M. Haissaguerre, and J. Clementy Radiofrequency ablation for atrial fibrillation Eur. Heart J. Suppl., September 1, 2003; 5(suppl_H): H34 - H39. [Abstract] [PDF]
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J. Kalifa, J. Jalife, A. V. Zaitsev, S. Bagwe, M. Warren, J. Moreno, O. Berenfeld, and S. Nattel Intra-Atrial Pressure Increases Rate and Organization of Waves Emanating From the Superior Pulmonary Veins During Atrial Fibrillation Circulation, August 12, 2003; 108(6): 668 - 671. [Abstract] [Full Text] [PDF]
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R. Kato, L. Lickfett, G. Meininger, T. Dickfeld, R. Wu, G. Juang, P. Angkeow, J. LaCorte, D. Bluemke, R. Berger, et al. Pulmonary Vein Anatomy in Patients Undergoing Catheter Ablation of Atrial Fibrillation: Lessons Learned by Use of Magnetic Resonance Imaging Circulation, April 22, 2003; 107(15): 2004 - 2010. [Abstract] [Full Text] [PDF]
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D. Schwartzman, J. Lacomis, and W. G. Wigginton Characterization of left atrium and distal pulmonary vein morphology using multidimensional computed tomography J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1349 - 1357. [Abstract] [Full Text] [PDF]
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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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F. H.M. Wittkampf, E.-J. Vonken, R. Derksen, P. Loh, B. Velthuis, E. F.D. Wever, L. V.A. Boersma, B. J. Rensing, and M.-J. Cramer Pulmonary Vein Ostium Geometry: Analysis by Magnetic Resonance Angiography Circulation, January 7, 2003; 107(1): 21 - 23. [Abstract] [Full Text] [PDF]
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K. S. Lindgren, M. J. Pekka Raatikainen, K. E. Juhani Airaksinen, and H. V. Huikuri Relationship between the frequency of paroxysmal episodes of atrial fibrillation and pulmonary venous flow pattern Europace, January 1, 2003; 5(1): 17 - 23. [Abstract] [PDF]
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I. Savelieva and A. John Camm Atrial fibrillation and heart failure: natural history and pharmacological treatment Europace, January 1, 2003; 5(s1): S5 - S19. [Abstract] [Full Text] [PDF]
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 F. Yazar, O. Ozdogmus, E. Tuccar, A. Bayramoglu, and H. Ozan Drainage patterns of middle lobe vein of right lung: an anatomical study Eur. J. Cardiothorac. Surg., November 1, 2002; 22(5): 717 - 720. [Abstract] [Full Text] [PDF]
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J. A. Cabrera, D. Sanchez-Quintana, J. Farre, F. Navarro, J. M. Rubio, F. Cabestrero, R. H. Anderson, and S. Y. Ho Ultrasonic Characterization of the Pulmonary Venous Wall: Echographic and Histological Correlation Circulation, August 20, 2002; 106(8): 968 - 973. [Abstract] [Full Text] [PDF]
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N. F. Marrouche, T. Dresing, C. Cole, D. Bash, E. Saad, K. Balaban, S. V. Pavia, R. Schweikert, W. Saliba, A. Abdul-Karim, et al. Circular mapping and ablation of thepulmonary vein for treatment of atrial fibrillation: Impact of different catheter technologies J. Am. Coll. Cardiol., August 7, 2002; 40(3): 464 - 474. [Abstract] [Full Text] [PDF]
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J. M.T. de Bakker, S. Y. Ho, and M. Hocini Basic and clinical electrophysiology of pulmonary vein ectopy Cardiovasc Res, May 1, 2002; 54(2): 287 - 294. [Abstract] [Full Text] [PDF]
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P. Jais, R. Weerasooriya, D. C. Shah, M. Hocini, L. Macle, K.-J. Choi, C. Scavee, M. Haissaguerre, and J. Clementy Ablation therapy for atrial fibrillation (AF): Past, present and future Cardiovasc Res, May 1, 2002; 54(2): 337 - 346. [Abstract] [Full Text] [PDF]
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 J. G. Ravenel and H. P. McAdams Pulmonary Venous Infarction After Radiofrequency Ablation for Atrial Fibrillation Am. J. Roentgenol., March 1, 2002; 178(3): 664 - 666. [Full Text] [PDF]
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 G.Y.H. Lip and F.L. L. S. Hee Paroxysmal atrial fibrillation QJM, December 1, 2001; 94(12): 665 - 678. [Abstract] [Full Text] [PDF]
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S Y Ho, J A Cabrera, V H Tran, J Farre, R H Anderson, and D Sanchez-Quintana Architecture of the pulmonary veins: relevance to radiofrequency ablation Heart, September 1, 2001; 86(3): 265 - 270. [Abstract] [Full Text] [PDF]
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