Mechanisms of recurrent atrial fibrillation: Comparisons between segmental ostial versus circumferential pulmonary vein isolation

Li Wei Lo, Ching Tai Tai, Yenn Jiang Lin, Shih Lin Chang, Wanwarang Wongcharoen, Ming Hsiung Hsieh, Ta Chuan Tuan, Ameya R. Udyavar, Yu Feng Hu, Yi Jen Chen, Hsuan Ming Tsao, Shih Ann Chen

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Electrical isolation of pulmonary veins (PVs) is an effective therapy for atrial fibrillation (AF). Both segmental ostial PV ablation and circumferential ablation with PV-left atrial (LA) block have been implicated to eliminate AF. However, the mechanism of the recurrent AF after undergoing either strategy remains unclear. Methods and Results: Of the 73 consecutive patients with symptomatic AF that underwent PV isolation and had recurrences of AF, Group 1 consisted of 46 patients (age 56 ± 13 years old, 35 males) who underwent PV isolation by segmental ostial PV ablation and Group 2 consisted of 27 patients (age 51 ± 11 years old, 24 males) who underwent circumferential ablation with PV-LA block. In Group 1, the earliest ectopic beat or ostial PV potentials were targeted. In Group 2, circumferential ablation with PV-LA block was performed by encircling the extraostial regions around the left and right PVs. During the first procedure, all patients had PV-AF. There was no difference in the non-PV ectopy between Group 1 and Group 2. During the second procedure, the incidence of an LA posterior wall ectopy initiating AF was significantly lower (20% vs. 0%, P = 0.01) in Group 2. There was no difference in the PV ectopy initiating AF during the second procedure. Conclusion: Circumferential ablation of AF with PV-LA block may eliminate the LA posterior wall ectopy and decrease the incidence of LA posterior wall ectopy initiating AF during the second procedure.

Original languageEnglish
Pages (from-to)803-807
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume18
Issue number8
DOIs
Publication statusPublished - Aug 2007

Fingerprint

Pulmonary Veins
Atrial Fibrillation
Incidence
Veins

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Left atrium

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Mechanisms of recurrent atrial fibrillation : Comparisons between segmental ostial versus circumferential pulmonary vein isolation. / Lo, Li Wei; Tai, Ching Tai; Lin, Yenn Jiang; Chang, Shih Lin; Wongcharoen, Wanwarang; Hsieh, Ming Hsiung; Tuan, Ta Chuan; Udyavar, Ameya R.; Hu, Yu Feng; Chen, Yi Jen; Tsao, Hsuan Ming; Chen, Shih Ann.

In: Journal of Cardiovascular Electrophysiology, Vol. 18, No. 8, 08.2007, p. 803-807.

Research output: Contribution to journalArticle

Lo, Li Wei ; Tai, Ching Tai ; Lin, Yenn Jiang ; Chang, Shih Lin ; Wongcharoen, Wanwarang ; Hsieh, Ming Hsiung ; Tuan, Ta Chuan ; Udyavar, Ameya R. ; Hu, Yu Feng ; Chen, Yi Jen ; Tsao, Hsuan Ming ; Chen, Shih Ann. / Mechanisms of recurrent atrial fibrillation : Comparisons between segmental ostial versus circumferential pulmonary vein isolation. In: Journal of Cardiovascular Electrophysiology. 2007 ; Vol. 18, No. 8. pp. 803-807.
@article{af1b70d4cdec43b2a9802c69d07f831f,
title = "Mechanisms of recurrent atrial fibrillation: Comparisons between segmental ostial versus circumferential pulmonary vein isolation",
abstract = "Background: Electrical isolation of pulmonary veins (PVs) is an effective therapy for atrial fibrillation (AF). Both segmental ostial PV ablation and circumferential ablation with PV-left atrial (LA) block have been implicated to eliminate AF. However, the mechanism of the recurrent AF after undergoing either strategy remains unclear. Methods and Results: Of the 73 consecutive patients with symptomatic AF that underwent PV isolation and had recurrences of AF, Group 1 consisted of 46 patients (age 56 ± 13 years old, 35 males) who underwent PV isolation by segmental ostial PV ablation and Group 2 consisted of 27 patients (age 51 ± 11 years old, 24 males) who underwent circumferential ablation with PV-LA block. In Group 1, the earliest ectopic beat or ostial PV potentials were targeted. In Group 2, circumferential ablation with PV-LA block was performed by encircling the extraostial regions around the left and right PVs. During the first procedure, all patients had PV-AF. There was no difference in the non-PV ectopy between Group 1 and Group 2. During the second procedure, the incidence of an LA posterior wall ectopy initiating AF was significantly lower (20{\%} vs. 0{\%}, P = 0.01) in Group 2. There was no difference in the PV ectopy initiating AF during the second procedure. Conclusion: Circumferential ablation of AF with PV-LA block may eliminate the LA posterior wall ectopy and decrease the incidence of LA posterior wall ectopy initiating AF during the second procedure.",
keywords = "Atrial fibrillation, Catheter ablation, Left atrium",
author = "Lo, {Li Wei} and Tai, {Ching Tai} and Lin, {Yenn Jiang} and Chang, {Shih Lin} and Wanwarang Wongcharoen and Hsieh, {Ming Hsiung} and Tuan, {Ta Chuan} and Udyavar, {Ameya R.} and Hu, {Yu Feng} and Chen, {Yi Jen} and Tsao, {Hsuan Ming} and Chen, {Shih Ann}",
year = "2007",
month = "8",
doi = "10.1111/j.1540-8167.2007.00848.x",
language = "English",
volume = "18",
pages = "803--807",
journal = "Journal of Cardiovascular Electrophysiology",
issn = "1045-3873",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Mechanisms of recurrent atrial fibrillation

T2 - Comparisons between segmental ostial versus circumferential pulmonary vein isolation

AU - Lo, Li Wei

AU - Tai, Ching Tai

AU - Lin, Yenn Jiang

AU - Chang, Shih Lin

AU - Wongcharoen, Wanwarang

AU - Hsieh, Ming Hsiung

AU - Tuan, Ta Chuan

AU - Udyavar, Ameya R.

AU - Hu, Yu Feng

AU - Chen, Yi Jen

AU - Tsao, Hsuan Ming

AU - Chen, Shih Ann

PY - 2007/8

Y1 - 2007/8

N2 - Background: Electrical isolation of pulmonary veins (PVs) is an effective therapy for atrial fibrillation (AF). Both segmental ostial PV ablation and circumferential ablation with PV-left atrial (LA) block have been implicated to eliminate AF. However, the mechanism of the recurrent AF after undergoing either strategy remains unclear. Methods and Results: Of the 73 consecutive patients with symptomatic AF that underwent PV isolation and had recurrences of AF, Group 1 consisted of 46 patients (age 56 ± 13 years old, 35 males) who underwent PV isolation by segmental ostial PV ablation and Group 2 consisted of 27 patients (age 51 ± 11 years old, 24 males) who underwent circumferential ablation with PV-LA block. In Group 1, the earliest ectopic beat or ostial PV potentials were targeted. In Group 2, circumferential ablation with PV-LA block was performed by encircling the extraostial regions around the left and right PVs. During the first procedure, all patients had PV-AF. There was no difference in the non-PV ectopy between Group 1 and Group 2. During the second procedure, the incidence of an LA posterior wall ectopy initiating AF was significantly lower (20% vs. 0%, P = 0.01) in Group 2. There was no difference in the PV ectopy initiating AF during the second procedure. Conclusion: Circumferential ablation of AF with PV-LA block may eliminate the LA posterior wall ectopy and decrease the incidence of LA posterior wall ectopy initiating AF during the second procedure.

AB - Background: Electrical isolation of pulmonary veins (PVs) is an effective therapy for atrial fibrillation (AF). Both segmental ostial PV ablation and circumferential ablation with PV-left atrial (LA) block have been implicated to eliminate AF. However, the mechanism of the recurrent AF after undergoing either strategy remains unclear. Methods and Results: Of the 73 consecutive patients with symptomatic AF that underwent PV isolation and had recurrences of AF, Group 1 consisted of 46 patients (age 56 ± 13 years old, 35 males) who underwent PV isolation by segmental ostial PV ablation and Group 2 consisted of 27 patients (age 51 ± 11 years old, 24 males) who underwent circumferential ablation with PV-LA block. In Group 1, the earliest ectopic beat or ostial PV potentials were targeted. In Group 2, circumferential ablation with PV-LA block was performed by encircling the extraostial regions around the left and right PVs. During the first procedure, all patients had PV-AF. There was no difference in the non-PV ectopy between Group 1 and Group 2. During the second procedure, the incidence of an LA posterior wall ectopy initiating AF was significantly lower (20% vs. 0%, P = 0.01) in Group 2. There was no difference in the PV ectopy initiating AF during the second procedure. Conclusion: Circumferential ablation of AF with PV-LA block may eliminate the LA posterior wall ectopy and decrease the incidence of LA posterior wall ectopy initiating AF during the second procedure.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Left atrium

UR - http://www.scopus.com/inward/record.url?scp=34447623935&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34447623935&partnerID=8YFLogxK

U2 - 10.1111/j.1540-8167.2007.00848.x

DO - 10.1111/j.1540-8167.2007.00848.x

M3 - Article

C2 - 17504254

AN - SCOPUS:34447623935

VL - 18

SP - 803

EP - 807

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

IS - 8

ER -