Identification of pulmonary vein foci by non-contact mapping in patients with paroxysmal atrial fibrillation.

Abstract

AIMS:

Ectopies from the pulmonary veins may cause paroxysmal atrial fibrillation and their discrete ablation may be curative. In the absence of focal activity during the procedure, identification of target sites with conventional techniques is difficult. We investigated the feasibility of non-contact mapping (EnSite) for identification and successful ablation of pulmonary vein foci in such cases.

METHODS AND RESULTS:

We studied 7 patients with idiopathic paroxysmal atrial fibrillation referred for percutaneous ablation and not presenting spontaneous or inducible atrial premature beats during the procedure. An EnSite balloon catheter and an ablation catheter (NaviStar) were placed inside the left atrium. The ablation catheter was also used for electroanatomic mapping (CARTO) of specific sites. Multiphasic pulmonary vein potentials were detected on virtual electrograms and tagged on the non-contact map and confirmed with conventional mapping. The procedural endpoint was elimination or dissociation of the multiphasic potential. Non-contact mapping identified 13 foci of multiphasic potentials in the seven patients (5 foci were initially identified by EnSite), and discrete ablation suppressed 9 of them (69%). Six months later, 4 of the 5 patients in whom all foci were suppressed remain asymptomatic, in sinus rhythm, under no medication.

CONCLUSION:

In patients with paroxysmal atrial fibrillation and no ectopic activity during electrophysiological study virtual electrograms may complement conventional techniques in detecting hidden pulmonary vein foci and may be used to evaluate ablation efficacy.

• Authors: Pedro Adragão, Diogo Cavaco, Carlos Aguiar, José Palos, Francisco Morgado, Regina Ribeiras, Miguel Abecasis, José Neves, Daniel Bonhorst, Ricardo Seabra-Gomes
• Journal: Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology (Rev Port Cardiol) Vol. 22 Issue 4 Pg. 475-86 (Apr 2003) ISSN: 0870-2551 [Print] Portugal
• PMID: 12879640 (Publication Type: Journal Article)

Topics

• Aged
• Atrial Fibrillation (etiology, pathology, physiopathology, surgery)
• Catheter Ablation
• Catheterization
• Electrophysiology
• Female
• Heart Atria (pathology)
• Humans
• Male
• Middle Aged
• Pulmonary Veins (abnormalities, pathology, physiopathology, surgery)