Circumferential Mapping And Electric Isolation Of Pulmonary Veins In Patients With Paroxysmal Atrial Fibrillation

Objective: Paroxysmal atrial fibrillation (AF) is frequently initiated from pulmonary veins (PVs), The aim of this study was to investigate: (1)the electrophysiological characteristics of pulmonary veins; (2) the clinical efficacy and complications of the circumferential mapping and isolation of the PVs; (3) the effect of segmental ostial radiofrequency ablation on PV anatomy in patients with paroxysmal AF. Method: The present study included thirty patients (mean age 53. 2 +/- 8. 1 years, 11 women) with frequent episodes of durg-refractory paroxysmal AF. Multiple electrode catheters were placed for mapping in the high right atrium (HRA), coronary sinus (CS) and PVs. Mapping of PVs was performed with a decapolar Lasso circumferential mapping catheter. After preferential PV-left atrium (LA) electric inputs were defined, radiofrequency ablation was performed until complete isolation of the PVs from the LA was achieved.Twenty patients only disconnect arrhythmogenic PVs, the others underwent four PVs and superior vena cava isolation routinely. Three-dimensional models of the PVs were constructed from computed tomographic (CT) scans in 14 patients with AF undergoing segmental ostial ablation to isolate the PVs and in 40 control subjects without a history of AF. the ostium of the left superior, left inferior, right superior, right inferior PVs were measured with digital calipers. Detailed follow-up at 1, 3, 6, and 12 months after intervention was performed. Results: A total of 106 veins were isolated. The distribution of veins was right superior PV, 27; left superior PV, 27; left inferior PV, 18; right inferior PV, 14; and superior vena cava ,20. Isthmus ablation was performed in 4 patients due to combine with atrial flutter. During follow-up, 3 patients underwent a second ablation procedure owe to recurrence. Twenty patients only disconnect arrhythmogenic PVs, after a mean follow-up period of 7.7 +/- 6.2 months, 11 (55%) of 20 patients had no recurrence of AF or were clinically improved ( 2 patients took anti-arrhythmic drugs). Ten patients underwent four PVs and superior vena cava isolation systematically, all patients had no recurrence of AF or were clinically improved (3 patients took anti-arrhythmic drugs). Recurrences were related to resumption of PV muscle-left atrial conduction or non-PV foci. The anatomy of the PVs was analyzed in 14 patients. The superior PVs had a larger ostium than the inferior PVs. PV stenosis was detected in 7 patients ( <50% in 5 patients and >50% in 2 patients). A 25% to 75% focal stenosis was present at the ostium in 9 of 39 isolated PVs. One patient had slight shortness of breath. The ostium size was not different between patients with AF and controls. Conclusion: AF originating from pulmonary veins hadAtrial fibrillation; Pulmonary veins; Catheter ablation; Electrophysiology; Tomography, X-ray Computedafter procedure. Results Twenty-nine patients achieved the procedural endpoint. After a mean follow-up of 1~26 (7. 7±6. 2) months, 17 patients were free from AF without antiarrhythmic drug, 5 patients were recurrence-free taking previously ineffective drug. Using SF-36, patients experience a significant improvement in QOL after a successful catheter ablation (besides body pain). Patients also had a significant chang in clinical symptoms (expect chest pain). Conclusions Catheter ablation is safe for treatment of part of paroxysmal AF, patients with a successful catheter ablation had a significant improve-ment in QOL and symptoms .