BACKGROUND: Pulmonary vein (PV) isolation has become a cornerstone for ablation of atrial fibrillation (AF). Circular mapping catheter (CMC)-guided techniques for detection of lesion gaps are challenging. OBJECTIVE: The present study describes a new concept of circumferential PV ablation aiming at bidirectional conduction block based on simultaneous pacing and ablation through the tip of a single mapping/ablation catheter. METHODS: A total of 147 patients with AF received circumferential PV ablation. In persistent AF, a posterior "box" lesion and a mitral isthmus line were added. All procedures were performed in sinus rhythm. Gaps within the left atrial (LA) ablation lines were detected and closed using voltage and pace mapping through the mapping/ablation catheter. Bidirectional conduction block was the procedural end point. Subsequently, the end point was validated by an independent electrophysiologist using a CMC. RESULTS: Procedural and radiation time measured 188 +/- 55 and 37 +/- 15 min. Bidirectional PV conduction block (lack of PV potentials and lack of LA capture) was found in 140 of 147 (95%) patients with single mapping/ablation catheter and in 138 of 147 (94%) patients with CMC. Early PV reconduction was seen in 22 of 147 (15%) patients. After 12 months follow-up, 84% of the patients were free from AF and/or atrial macro-re-entrant tachycardia. The rate of reablations was 10% and 24% for patients with paroxysmal and persistent AF, respectively. CONCLUSION: Pacing and ablation from the tip of the mapping/ablation catheter is feasible to detect and close gaps within long atrial ablation lines to consistently achieve bidirectional conduction block.
BACKGROUND: Pulmonary vein (PV) isolation has become a cornerstone for ablation of atrial fibrillation (AF). Circular mapping catheter (CMC)-guided techniques for detection of lesion gaps are challenging. OBJECTIVE: The present study describes a new concept of circumferential PV ablation aiming at bidirectional conduction block based on simultaneous pacing and ablation through the tip of a single mapping/ablation catheter. METHODS: A total of 147 patients with AF received circumferential PV ablation. In persistent AF, a posterior "box" lesion and a mitral isthmus line were added. All procedures were performed in sinus rhythm. Gaps within the left atrial (LA) ablation lines were detected and closed using voltage and pace mapping through the mapping/ablation catheter. Bidirectional conduction block was the procedural end point. Subsequently, the end point was validated by an independent electrophysiologist using a CMC. RESULTS: Procedural and radiation time measured 188 +/- 55 and 37 +/- 15 min. Bidirectional PV conduction block (lack of PV potentials and lack of LA capture) was found in 140 of 147 (95%) patients with single mapping/ablation catheter and in 138 of 147 (94%) patients with CMC. Early PV reconduction was seen in 22 of 147 (15%) patients. After 12 months follow-up, 84% of the patients were free from AF and/or atrial macro-re-entrant tachycardia. The rate of reablations was 10% and 24% for patients with paroxysmal and persistent AF, respectively. CONCLUSION: Pacing and ablation from the tip of the mapping/ablation catheter is feasible to detect and close gaps within long atrial ablation lines to consistently achieve bidirectional conduction block.
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Heart Rhythm Date: 2017-05-12 Impact factor: 6.343
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; José Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: Heart Rhythm Date: 2012-03-01 Impact factor: 6.343
Authors: Dirk Vollmann; Lars Lüthje; Joachim Seegers; Christian Sohns; Samuel Sossalla; Jan Sohns; Christian Röver; Gerd Hasenfuß; Markus Zabel Journal: J Interv Card Electrophysiol Date: 2014-06-04 Impact factor: 1.900
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Europace Date: 2018-01-01 Impact factor: 5.214
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: J Interv Card Electrophysiol Date: 2017-10 Impact factor: 1.900
Authors: Ravi Ranjan; Eugene G Kholmovski; Joshua Blauer; Sathya Vijayakumar; Nelly A Volland; Mohamed E Salama; Dennis L Parker; Rob MacLeod; Nassir F Marrouche Journal: Circ Arrhythm Electrophysiol Date: 2012-10-15