The Role of Left Atrial Muscular Bundles in Catheter Ablation of Atrial Fibrillation

Shih Lin Chang, Ching Tai Tai, Yenn Jiang Lin, Wanwarang Wongcharoen, Li Wei Lo, Kun Tai Lee, Sheng Hsiung Chang, Ta Chuan Tuan, Yi Jen Chen, Ming Hsiung Hsieh, Hsuan Ming Tsao, Mei Han Wu, Ming Huei Sheu, Cheng Yen Chang, Shih Ann Chen

Research output: Contribution to journalArticle

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Abstract

Objectives: We sought to investigate the imaging of the left atrial (LA) muscular bundle and the relationship between the bundle and inducibility of tachyarrhythmia after pulmonary vein isolation (PVI). Background: Noninducibility is used as a clinical end point of atrial substrate ablation after PVI. However, little is known about the role of the LA muscular bundles in tachyarrhythmia after PVI. Methods: Forty-three consecutive patients with paroxysmal atrial fibrillation who underwent catheter ablation were included. Bi-atrial isochronal mapping was performed with the NavX system (St. Jude Medical Inc., St. Paul, Minnesota) during sinus rhythm. After 4 PVI, inducible organized LA flutter with or without transforming to atrial fibrillation (AF) (LA flutter/AF) was ablated with additional lines at the roof and/or mitral isthmus. Results: The existence of bilateral muscular bundles was an independent predictor of LA flutter/AF after PVI (p = 0.02). Patients with LA flutter/AF after PVI had a greater index of the double potentials (5.4 ± 3.4% vs. 2.8 ± 1.8%, p = 0.006) and interpotential interval (33 ± 5 ms vs. 29 ± 4 ms, p = 0.02) than without LA flutter/AF. The muscular bundles were identified in 28% patients using 16-slice multidetector computed tomography, which were identical to the isochrone map. Patients with noninducible LA flutter/AF after PVI plus the additional linear ablation had a lower recurrence rate as compared with the patients without it (19% vs. 75%, p = 0.02). Conclusions: Left atrial muscular bundles may provide a conduction block line and barrier, which is important for the formation of LA flutter/AF after PVI. The noninducibility of LA flutter/AF achieved after additional linear ablation may contribute to a better outcome in RF ablation of paroxysmal atrial fibrillation.

Original languageEnglish
Pages (from-to)964-973
Number of pages10
JournalJournal of the American College of Cardiology
Volume50
Issue number10
DOIs
Publication statusPublished - Sep 4 2007

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Catheter Ablation
Atrial Flutter
Atrial Fibrillation
Pulmonary Veins
Tachycardia
Multidetector Computed Tomography
Recurrence

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Chang, S. L., Tai, C. T., Lin, Y. J., Wongcharoen, W., Lo, L. W., Lee, K. T., ... Chen, S. A. (2007). The Role of Left Atrial Muscular Bundles in Catheter Ablation of Atrial Fibrillation. Journal of the American College of Cardiology, 50(10), 964-973. https://doi.org/10.1016/j.jacc.2007.05.026

The Role of Left Atrial Muscular Bundles in Catheter Ablation of Atrial Fibrillation. / Chang, Shih Lin; Tai, Ching Tai; Lin, Yenn Jiang; Wongcharoen, Wanwarang; Lo, Li Wei; Lee, Kun Tai; Chang, Sheng Hsiung; Tuan, Ta Chuan; Chen, Yi Jen; Hsieh, Ming Hsiung; Tsao, Hsuan Ming; Wu, Mei Han; Sheu, Ming Huei; Chang, Cheng Yen; Chen, Shih Ann.

In: Journal of the American College of Cardiology, Vol. 50, No. 10, 04.09.2007, p. 964-973.

Research output: Contribution to journalArticle

Chang, SL, Tai, CT, Lin, YJ, Wongcharoen, W, Lo, LW, Lee, KT, Chang, SH, Tuan, TC, Chen, YJ, Hsieh, MH, Tsao, HM, Wu, MH, Sheu, MH, Chang, CY & Chen, SA 2007, 'The Role of Left Atrial Muscular Bundles in Catheter Ablation of Atrial Fibrillation', Journal of the American College of Cardiology, vol. 50, no. 10, pp. 964-973. https://doi.org/10.1016/j.jacc.2007.05.026
Chang, Shih Lin ; Tai, Ching Tai ; Lin, Yenn Jiang ; Wongcharoen, Wanwarang ; Lo, Li Wei ; Lee, Kun Tai ; Chang, Sheng Hsiung ; Tuan, Ta Chuan ; Chen, Yi Jen ; Hsieh, Ming Hsiung ; Tsao, Hsuan Ming ; Wu, Mei Han ; Sheu, Ming Huei ; Chang, Cheng Yen ; Chen, Shih Ann. / The Role of Left Atrial Muscular Bundles in Catheter Ablation of Atrial Fibrillation. In: Journal of the American College of Cardiology. 2007 ; Vol. 50, No. 10. pp. 964-973.
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abstract = "Objectives: We sought to investigate the imaging of the left atrial (LA) muscular bundle and the relationship between the bundle and inducibility of tachyarrhythmia after pulmonary vein isolation (PVI). Background: Noninducibility is used as a clinical end point of atrial substrate ablation after PVI. However, little is known about the role of the LA muscular bundles in tachyarrhythmia after PVI. Methods: Forty-three consecutive patients with paroxysmal atrial fibrillation who underwent catheter ablation were included. Bi-atrial isochronal mapping was performed with the NavX system (St. Jude Medical Inc., St. Paul, Minnesota) during sinus rhythm. After 4 PVI, inducible organized LA flutter with or without transforming to atrial fibrillation (AF) (LA flutter/AF) was ablated with additional lines at the roof and/or mitral isthmus. Results: The existence of bilateral muscular bundles was an independent predictor of LA flutter/AF after PVI (p = 0.02). Patients with LA flutter/AF after PVI had a greater index of the double potentials (5.4 ± 3.4{\%} vs. 2.8 ± 1.8{\%}, p = 0.006) and interpotential interval (33 ± 5 ms vs. 29 ± 4 ms, p = 0.02) than without LA flutter/AF. The muscular bundles were identified in 28{\%} patients using 16-slice multidetector computed tomography, which were identical to the isochrone map. Patients with noninducible LA flutter/AF after PVI plus the additional linear ablation had a lower recurrence rate as compared with the patients without it (19{\%} vs. 75{\%}, p = 0.02). Conclusions: Left atrial muscular bundles may provide a conduction block line and barrier, which is important for the formation of LA flutter/AF after PVI. The noninducibility of LA flutter/AF achieved after additional linear ablation may contribute to a better outcome in RF ablation of paroxysmal atrial fibrillation.",
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T1 - The Role of Left Atrial Muscular Bundles in Catheter Ablation of Atrial Fibrillation

AU - Chang, Shih Lin

AU - Tai, Ching Tai

AU - Lin, Yenn Jiang

AU - Wongcharoen, Wanwarang

AU - Lo, Li Wei

AU - Lee, Kun Tai

AU - Chang, Sheng Hsiung

AU - Tuan, Ta Chuan

AU - Chen, Yi Jen

AU - Hsieh, Ming Hsiung

AU - Tsao, Hsuan Ming

AU - Wu, Mei Han

AU - Sheu, Ming Huei

AU - Chang, Cheng Yen

AU - Chen, Shih Ann

PY - 2007/9/4

Y1 - 2007/9/4

N2 - Objectives: We sought to investigate the imaging of the left atrial (LA) muscular bundle and the relationship between the bundle and inducibility of tachyarrhythmia after pulmonary vein isolation (PVI). Background: Noninducibility is used as a clinical end point of atrial substrate ablation after PVI. However, little is known about the role of the LA muscular bundles in tachyarrhythmia after PVI. Methods: Forty-three consecutive patients with paroxysmal atrial fibrillation who underwent catheter ablation were included. Bi-atrial isochronal mapping was performed with the NavX system (St. Jude Medical Inc., St. Paul, Minnesota) during sinus rhythm. After 4 PVI, inducible organized LA flutter with or without transforming to atrial fibrillation (AF) (LA flutter/AF) was ablated with additional lines at the roof and/or mitral isthmus. Results: The existence of bilateral muscular bundles was an independent predictor of LA flutter/AF after PVI (p = 0.02). Patients with LA flutter/AF after PVI had a greater index of the double potentials (5.4 ± 3.4% vs. 2.8 ± 1.8%, p = 0.006) and interpotential interval (33 ± 5 ms vs. 29 ± 4 ms, p = 0.02) than without LA flutter/AF. The muscular bundles were identified in 28% patients using 16-slice multidetector computed tomography, which were identical to the isochrone map. Patients with noninducible LA flutter/AF after PVI plus the additional linear ablation had a lower recurrence rate as compared with the patients without it (19% vs. 75%, p = 0.02). Conclusions: Left atrial muscular bundles may provide a conduction block line and barrier, which is important for the formation of LA flutter/AF after PVI. The noninducibility of LA flutter/AF achieved after additional linear ablation may contribute to a better outcome in RF ablation of paroxysmal atrial fibrillation.

AB - Objectives: We sought to investigate the imaging of the left atrial (LA) muscular bundle and the relationship between the bundle and inducibility of tachyarrhythmia after pulmonary vein isolation (PVI). Background: Noninducibility is used as a clinical end point of atrial substrate ablation after PVI. However, little is known about the role of the LA muscular bundles in tachyarrhythmia after PVI. Methods: Forty-three consecutive patients with paroxysmal atrial fibrillation who underwent catheter ablation were included. Bi-atrial isochronal mapping was performed with the NavX system (St. Jude Medical Inc., St. Paul, Minnesota) during sinus rhythm. After 4 PVI, inducible organized LA flutter with or without transforming to atrial fibrillation (AF) (LA flutter/AF) was ablated with additional lines at the roof and/or mitral isthmus. Results: The existence of bilateral muscular bundles was an independent predictor of LA flutter/AF after PVI (p = 0.02). Patients with LA flutter/AF after PVI had a greater index of the double potentials (5.4 ± 3.4% vs. 2.8 ± 1.8%, p = 0.006) and interpotential interval (33 ± 5 ms vs. 29 ± 4 ms, p = 0.02) than without LA flutter/AF. The muscular bundles were identified in 28% patients using 16-slice multidetector computed tomography, which were identical to the isochrone map. Patients with noninducible LA flutter/AF after PVI plus the additional linear ablation had a lower recurrence rate as compared with the patients without it (19% vs. 75%, p = 0.02). Conclusions: Left atrial muscular bundles may provide a conduction block line and barrier, which is important for the formation of LA flutter/AF after PVI. The noninducibility of LA flutter/AF achieved after additional linear ablation may contribute to a better outcome in RF ablation of paroxysmal atrial fibrillation.

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