Electrophysiological characteristics and catheter ablation in patients with paroxysmal right atrial fibrillation

Yenn Jiang Lin, Ching Tai Tai, Tsair Kao, Han Wen Tso, Jin Long Huang, Satoshi Higa, Yoga Yuniadi, Bien Hsien Huang, Tu Ying Liu, Pi Chang Lee, Ming Hsiung Hsieh, Shih Ann Chen

Research output: Contribution to journalArticle

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Abstract

Background - Catheter ablation of the right atrial (RA) substrate has had variable efficacy in curing paroxysmal atrial fibrillation (PAF), suggesting that RA substrate ablation can play an important role in the treatment of atrial fibrillation (AF) in some patients. The aim of this study was to investigate the electrophysiological characteristics and ablation strategy and its results in a specific group of patients with paroxysmal RA-AF. Methods and Results - The study population consisted of 13 patients (8 men; age, 64±15 years) with drug-refractory (2±1 drugs), frequent episodes of PAF. Provocation maneuvers did not reveal any ectopic beat-initiating AF. However, rapid atrial pacing easily induced AF. Activation mapping during sinus rhythm, atrial pacing, and AF was visualized by using a noncontact mapping system. Noncontact mapping revealed RA reentry (6 patients with single-loop circuits and 7 with double-loop circuits) with conduction through channels between lines of block, crista terminalis gaps, and the cavotricuspid isthmus, which could be identified during sinus rhythm and atrial pacing, resulting in fibrillatory conduction in other parts of the RA. The consistency of wavefront activation was confirmed by frequency analysis from equally distributed mapping sites in the RA. Short lines of ablation lesions were aimed at the conduction channels between the lines of block, crista terminalis gaps, and the cavotricuspid isthmus, resulting in bidirectional block. AF was eliminated in 11 (85%) of 13 patients, and those 11 patients with acute success were free of AF without any antiarrhythmic drugs during the long-term follow-up period (16±6 months). Conclusions - RA ablation still can cure selected patients with PAF. Linear ablation of the RA substrate guided by the electrophysiological characteristics of RA-AF is an effective approach for treating this specific group of patients with AF.

Original languageEnglish
Pages (from-to)1692-1700
Number of pages9
JournalCirculation
Volume112
Issue number12
DOIs
Publication statusPublished - Sep 20 2005
Externally publishedYes

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Catheter Ablation
Atrial Fibrillation
Anti-Arrhythmia Agents
Pharmaceutical Preparations

Keywords

  • Ablation
  • Atrial fibrillation
  • Atrium

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Lin, Y. J., Tai, C. T., Kao, T., Tso, H. W., Huang, J. L., Higa, S., ... Chen, S. A. (2005). Electrophysiological characteristics and catheter ablation in patients with paroxysmal right atrial fibrillation. Circulation, 112(12), 1692-1700. https://doi.org/10.1161/CIRCULATIONAHA.104.512731

Electrophysiological characteristics and catheter ablation in patients with paroxysmal right atrial fibrillation. / Lin, Yenn Jiang; Tai, Ching Tai; Kao, Tsair; Tso, Han Wen; Huang, Jin Long; Higa, Satoshi; Yuniadi, Yoga; Huang, Bien Hsien; Liu, Tu Ying; Lee, Pi Chang; Hsieh, Ming Hsiung; Chen, Shih Ann.

In: Circulation, Vol. 112, No. 12, 20.09.2005, p. 1692-1700.

Research output: Contribution to journalArticle

Lin, YJ, Tai, CT, Kao, T, Tso, HW, Huang, JL, Higa, S, Yuniadi, Y, Huang, BH, Liu, TY, Lee, PC, Hsieh, MH & Chen, SA 2005, 'Electrophysiological characteristics and catheter ablation in patients with paroxysmal right atrial fibrillation', Circulation, vol. 112, no. 12, pp. 1692-1700. https://doi.org/10.1161/CIRCULATIONAHA.104.512731
Lin, Yenn Jiang ; Tai, Ching Tai ; Kao, Tsair ; Tso, Han Wen ; Huang, Jin Long ; Higa, Satoshi ; Yuniadi, Yoga ; Huang, Bien Hsien ; Liu, Tu Ying ; Lee, Pi Chang ; Hsieh, Ming Hsiung ; Chen, Shih Ann. / Electrophysiological characteristics and catheter ablation in patients with paroxysmal right atrial fibrillation. In: Circulation. 2005 ; Vol. 112, No. 12. pp. 1692-1700.
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abstract = "Background - Catheter ablation of the right atrial (RA) substrate has had variable efficacy in curing paroxysmal atrial fibrillation (PAF), suggesting that RA substrate ablation can play an important role in the treatment of atrial fibrillation (AF) in some patients. The aim of this study was to investigate the electrophysiological characteristics and ablation strategy and its results in a specific group of patients with paroxysmal RA-AF. Methods and Results - The study population consisted of 13 patients (8 men; age, 64±15 years) with drug-refractory (2±1 drugs), frequent episodes of PAF. Provocation maneuvers did not reveal any ectopic beat-initiating AF. However, rapid atrial pacing easily induced AF. Activation mapping during sinus rhythm, atrial pacing, and AF was visualized by using a noncontact mapping system. Noncontact mapping revealed RA reentry (6 patients with single-loop circuits and 7 with double-loop circuits) with conduction through channels between lines of block, crista terminalis gaps, and the cavotricuspid isthmus, which could be identified during sinus rhythm and atrial pacing, resulting in fibrillatory conduction in other parts of the RA. The consistency of wavefront activation was confirmed by frequency analysis from equally distributed mapping sites in the RA. Short lines of ablation lesions were aimed at the conduction channels between the lines of block, crista terminalis gaps, and the cavotricuspid isthmus, resulting in bidirectional block. AF was eliminated in 11 (85{\%}) of 13 patients, and those 11 patients with acute success were free of AF without any antiarrhythmic drugs during the long-term follow-up period (16±6 months). Conclusions - RA ablation still can cure selected patients with PAF. Linear ablation of the RA substrate guided by the electrophysiological characteristics of RA-AF is an effective approach for treating this specific group of patients with AF.",
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AU - Lin, Yenn Jiang

AU - Tai, Ching Tai

AU - Kao, Tsair

AU - Tso, Han Wen

AU - Huang, Jin Long

AU - Higa, Satoshi

AU - Yuniadi, Yoga

AU - Huang, Bien Hsien

AU - Liu, Tu Ying

AU - Lee, Pi Chang

AU - Hsieh, Ming Hsiung

AU - Chen, Shih Ann

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N2 - Background - Catheter ablation of the right atrial (RA) substrate has had variable efficacy in curing paroxysmal atrial fibrillation (PAF), suggesting that RA substrate ablation can play an important role in the treatment of atrial fibrillation (AF) in some patients. The aim of this study was to investigate the electrophysiological characteristics and ablation strategy and its results in a specific group of patients with paroxysmal RA-AF. Methods and Results - The study population consisted of 13 patients (8 men; age, 64±15 years) with drug-refractory (2±1 drugs), frequent episodes of PAF. Provocation maneuvers did not reveal any ectopic beat-initiating AF. However, rapid atrial pacing easily induced AF. Activation mapping during sinus rhythm, atrial pacing, and AF was visualized by using a noncontact mapping system. Noncontact mapping revealed RA reentry (6 patients with single-loop circuits and 7 with double-loop circuits) with conduction through channels between lines of block, crista terminalis gaps, and the cavotricuspid isthmus, which could be identified during sinus rhythm and atrial pacing, resulting in fibrillatory conduction in other parts of the RA. The consistency of wavefront activation was confirmed by frequency analysis from equally distributed mapping sites in the RA. Short lines of ablation lesions were aimed at the conduction channels between the lines of block, crista terminalis gaps, and the cavotricuspid isthmus, resulting in bidirectional block. AF was eliminated in 11 (85%) of 13 patients, and those 11 patients with acute success were free of AF without any antiarrhythmic drugs during the long-term follow-up period (16±6 months). Conclusions - RA ablation still can cure selected patients with PAF. Linear ablation of the RA substrate guided by the electrophysiological characteristics of RA-AF is an effective approach for treating this specific group of patients with AF.

AB - Background - Catheter ablation of the right atrial (RA) substrate has had variable efficacy in curing paroxysmal atrial fibrillation (PAF), suggesting that RA substrate ablation can play an important role in the treatment of atrial fibrillation (AF) in some patients. The aim of this study was to investigate the electrophysiological characteristics and ablation strategy and its results in a specific group of patients with paroxysmal RA-AF. Methods and Results - The study population consisted of 13 patients (8 men; age, 64±15 years) with drug-refractory (2±1 drugs), frequent episodes of PAF. Provocation maneuvers did not reveal any ectopic beat-initiating AF. However, rapid atrial pacing easily induced AF. Activation mapping during sinus rhythm, atrial pacing, and AF was visualized by using a noncontact mapping system. Noncontact mapping revealed RA reentry (6 patients with single-loop circuits and 7 with double-loop circuits) with conduction through channels between lines of block, crista terminalis gaps, and the cavotricuspid isthmus, which could be identified during sinus rhythm and atrial pacing, resulting in fibrillatory conduction in other parts of the RA. The consistency of wavefront activation was confirmed by frequency analysis from equally distributed mapping sites in the RA. Short lines of ablation lesions were aimed at the conduction channels between the lines of block, crista terminalis gaps, and the cavotricuspid isthmus, resulting in bidirectional block. AF was eliminated in 11 (85%) of 13 patients, and those 11 patients with acute success were free of AF without any antiarrhythmic drugs during the long-term follow-up period (16±6 months). Conclusions - RA ablation still can cure selected patients with PAF. Linear ablation of the RA substrate guided by the electrophysiological characteristics of RA-AF is an effective approach for treating this specific group of patients with AF.

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