Document Detail

Roles of the left atrial roof and pulmonary veins in the anatomic substrate for persistent atrial fibrillation and ablation in a canine model.
MedLine Citation:
PMID:  21070924     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: the aim of this study was to establish the electrophysiological consequences of pulmonary vein encircling ablation (PVEA) and linear left atrial roof ablation (LARA) for the atrial fibrillation (AF) substrate in an experimental model.
BACKGROUND: sequential application of ablation lesions is often used in the management of AF, almost always incorporating PVEA and LARA.
METHODS: Atrial tachypacing (400 beats/min, 5 weeks) was used to create an AF substrate in 13 dogs. PVEA and LARA were applied in randomized order. Regional atrial refractoriness, AF vulnerability, AF duration, and activation during AF were assessed before and after applying ablation lesion sets.
RESULTS: PVEA failed to terminate AF or affect AF duration (742 ± 242 s before vs. 627 ± 227 s after PVEA) but decreased AF vulnerability to single extrastimuli from 91 ± 4% to 59 ± 5% (p < 0.001) by increasing effective refractory periods at sites with suppressed AF induction (from 78 ± 4 ms to 102 ± 8 ms, p < 0.01). LARA terminated AF in 67% of dogs (p < 0.05 vs. PVEA) and reduced AF duration (from 934 ± 232 s to 322 ± 183 s, p < 0.01) without affecting AF vulnerability. Baseline AF mapping showed left atrial (LA)-dominant complex reactivations (LA 9.4 ± 0.9 vs. right atrial 1.1 ± 0.3 reactivations/500-ms window, p < 0.001), with the LA roof frequently involved in re-entry circuits (44 ± 9% of LA reactivations). LARA terminated AF by interrupting LA roof reactivation circuits. In 5 of 13 cases, macro-re-entrant tachycardias (usually perimitral) occurred after LARA eliminated persistent AF.
CONCLUSIONS: both PVEA and LARA had beneficial but limited actions in this canine model. LARA suppressed AF perpetuation by interrupting LA roof reactivation, without affecting AF vulnerability. PVEA suppressed AF initiation by prolonging regional effective refractory period but failed to affect the AF-perpetuating substrate. These findings indicate the need to systematically study individual stepwise components to refine AF ablation procedures.
Kunihiro Nishida; Jean-François Sarrazin; Akira Fujiki; Hakan Oral; Hiroshi Inoue; Fred Morady; Stanley Nattel
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  56     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-12     Completed Date:  2011-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1728-36     Citation Subset:  AIM; IM    
Copyright Information:
2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Research Center, Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
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MeSH Terms
Atrial Fibrillation / physiopathology*,  surgery
Catheter Ablation*
Disease Models, Animal
Electrophysiologic Techniques, Cardiac / methods
Heart Atria / innervation,  physiopathology*,  surgery
Heart Conduction System / physiopathology*,  surgery
Pulmonary Veins / innervation,  physiopathology*,  surgery
Grant Support
MGP 6957//Canadian Institutes of Health Research

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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