The Analysis Of Spontaneous Pulmonary Vein Potentials And Pericardial Effusion After Radiofrequency Catheter Ablation In Patients With Atrial Fibrillation

PartⅠCorrelation factors of spontaneous pulmonary vein potentials in patients with atrial fibrillation who underwent radiofrequency catheter ablationObjectiveThe correlation factors of spontaneous pulmonary vein(PV) potentials (SPVPs) in patients with atrial fibrillation(AF) who underwent circumferential PV isolation were evaluated.MethodsA total of 153 consecutive patients with AF who underwent radiofrequency catheter ablation from Jul 2004 to Dec 2005(57.6±11.2 years,male in 97, paroxysmal AF in 114) were included in this study.The mean duration of AF was 6.6±6.1 years.The maximum diameter of the basilar part of PVs was measured using CT angiography of PVs and 3D image software before procedure.Ablation was performed under the guidance of a three-dimensions mapping system(CARTO or CARTO-Merge,Biosense-Webster Inc.,Diamond Bar,California) and a circular mapping catheter(Lasso,Biosense-Webster Inc., Diamond Bar,California).SPVPs were recorded and evaluated by a multiple physiological recorder(Prucka,GE Medical Systems) after successful PV isolation.Those factors that maybe correlated with SPVPs were analyzed.Results1.Six hundred and twenty-one PVs were isolated in 153 patients.The SPVPs were identified in 125 PVs(20.1%) of 69 patients(45.1%).Of all PVs with SPVPs,two(1.6%) with adventitious SPVPs,121(96.0%) with slow and regular SPVPs,and 3(2.4%) with rapid SPVPs with regular or irregular rhythm.2.SPVPs often took some time to reach homeostasis after they were mapped and identified.While re-mapping after reinforced ablation or before the operation ended,it was found that the rate of SPVPs become slower in 22 PVs(9 of which the SPVPs disappeared finally),but become faster in another 10 PVs.Nine patients with the same rate of SPVPs in ipsilateral superior and inferior PVs,and 1 inferior PV with the rate a half of that of ipsilateral superior PV.3.The maximum diameter of left superior PVs(LSPV,18.5±4.0 mm) and right superior PVs(RSPV,18.7±4.2 mm) were both significantly larger than that of left inferior PVs(LIPV,15.2±3.0 mm) and right inferior PVs(RIPV, 16.3±3.8 mm)(p＜0.001,respectively).The maximum diameter of right PVs (the right superior and the right inferior PVs,17.5±4.2 mm) was significantly larger than that of left PVs(the left superior and the left inferior PVs, 16.8±3.9 mm)(p= 0.012).The maximum diameter of RSPV with spontaneous potentials was significantly larger than that of RSPV without spontaneous potentials(20.0±3.8 mm vs.18.3±4.3 mm;p=0.027).The incidence of SPVPs in right PVs was significantly higher than that in left PVs(25.5%vs.11.4%,p＜0.05).The incidence of SPVPs in RSPV(27.2%) and RIPV(23.8%) were significantly higher than that in LIPV(11.4%,p＜0.001 and p=0.005,respectively).The incidence of SPVPs in RSPV was positively correlated to the maximum diameter(β=0.097,exp(b) =1.102, 95%confidence interval:1.009～1.203,p=0.030).In addition,the incidence of SPVPs was not associated with the sex,age,type and duration of AF,the left atria diameter,and the use of medications before the procedure.Conclusions1.There are three patterns of SPVPs in patients with AF after PV isolation, most of which is slow and regular electrical activities.2.The instability is a character of SPVPs. 3.The incidence of SPVPs is related to the basilar diameter of PVs. PartⅡEvaluation and ablation of atrial arrhythmias induced by spontaneous pulmonary vein potentials during circumferential pulmonary vein isolationIntroductionThe recurrence of atrial arrhythmias(AAs) after circumferential pulmonary vein(PV) isolation(CPVI) in patients with atrial fibrillation is often due to the re-conduction between PVs and atrium,but it can also result from partly isolation of PVs.In this study,the AAs due to partly isolation of PVs indicated by unidirectional conduction between left atrium and PVs were evaluated and ablated.MethodsCPVI,combined with circumferential PV ablation and/or linear ablation and/or complex fractionated atrial electrograms ablation under the guidance of a three-dimensions mapping system(CARTO or CARTO-Merge, Biosense-Webster Inc.,Diamond Bar,California) and a circular mapping catheter(Lasso,Biosense-Webster Inc.,Diamond Bar,California),were performed in 266 consecutive patients from Jan 2006 to Jun 2007(male in 192, 56.9+11.1 years,paroxysmal AF in 193).SPVPs were recorded and evaluated by a multiple physiological recorder(Prucka,GE Medical Systems) after successful PV isolation.During operation,PVs with SPVPs which could induce AAs were identified,and then gap ablations were performed to completely isolate the target PVs.After that,bidirectional block between PVs and atrium were identified and evaluated.ResultsSPVPs were mapped in a total of 131 patients(49.2%) after CPVI.Those SPVPs that can conduct from PVs to atrium to induce AAs were indentified in 5 PVs(left inferior PV 2,left superior PV 1,right superior PV 1,and right inferior PV 1) of 5 patients(3.8%,5/131).The breakthrough points from PVs to atrium were identified and then ablations were performed to block those gaps.After that all target PVs were isolated completely and no AAs could be induced by SPVPs.Bidirectional block between PVs and atrium were confirmed by pacing in PVs and coronary sinus.Conclusions1.SPVPs after CPVI,which just manifested the unidirectional block from atrium to PVs,may conduct from PVs to atrium to induce AAs.This may due to the partly isolation during CPVI.2.For reducing the recurrence of AAs after CPVI,It is important to identify the unidirectional block between PVs and atrium and to isolate the target PVs completely. PartⅢManagement and risk factors associated with pericardial effusion in patients with atrial fibrillation who underwent radiofrequency catheter ablationIntroductionPericardial effusion(PE) is a major complication of atrial fibrillation(AF) ablation,and it may lead to cardiac tamponade(CT) but can also occur merely and without tamponade(pure PE,PPE).However,management of PE and risk factors associated with PPE in this population remain unknown.In this study, managements of PE and risk factors associated with PPE in patients with AF who underwent radiofrequency catheter ablation(RFCA) were investigated and evaluated.MethodsA total of 156 consecutive patients with AF from Jan 2006 to Dec 2006 (male 108,57.6±11.3 years,paroxysmal AF in 114 patients),underwent RFCA guided by a three-dimensional mapping system(CARTO or CARTO-Merge, Biosense-Webster Inc.,Diamond Bar,California) and a circular mapping catheter(Lasso,Biosense-Webster Inc.,Diamond Bar,California),were included in this study.The ablation strategy included circumferential pulmonary veins isolation(CPVl),linear ablation and/or complex fractionated atrial electrograms(CFAEs) ablation.Electrophysiological data and vital signs of patients were recorded by a multiple physiological recorder(Prucka, GE Medical Systems) during ablation.Ablation process,ablation sites,ablation duration and other factors were also recorded.Echocardiography and other examinations were performed to differentiated CT and PPE.After that, different managements were taken based on the states of patients.Those patients with PE were followed up in out-patient;echocardiography and other examinations were taken to evaluate the consequence.Risk factors which may associate with PPE were analyzed.Results 1.PE was indentified in 16 patients(10.3%),while CPVI were achieved in all 156 patients.One patient had acute CT just after the procedure,whose symptoms released after pericardiocentesis and exploratory thoracotomy, without any sequel after 18 months follow-up.PPE was confirmed in another 15 patients(9.62%,93.75%of PE),the symptoms were released after expectant treatment but not any invasive treatment.PE disappeared in 6 patients after 3 months and in the other 9 patients after 6 months without any sequel.2.The composition of gender(p＜0.001),ablation in the coronary sinus(CS, p = 0.026),ablation of CFAEs(p = 0.037) and superior vena cava(SVC,p = 0.041) had significant difference between those patients with PPE and without PPE or CT by univariate analysis.Female(13=3.594,exp(b) =36.4, 95%confidence interval(CI):4.24～312.1,p = 0.001) and ablation in the CS(13=2.419,exp(b) =11.2,95%CI:1.01～124.6,p = 0.049),revealed by Logistic regression analysis,were the two independent risk factors associated with PPE after AF ablation.Conclusions1.PE could be encountered frequently after extensive ablation in patients with AF,but most of them appeared as PPE that could be managed with expectant treatment and without any sequel.2.PPE after AF ablation is self-limited,which may due to the inflammation exudation caused by ablation lesion.3.Female and ablation in the CS were the two independent risk factors associated with PPE,ablation of CFAEs and SVC could also increase the incidence of PPE,so cautions must be taken when ablation were delivered at those sites(CS,CFAEs and SVC) to reduce the incidence of PPE as much as possible.