Bezold-Jarisch-like reflex during radiofrequency ablation of the pulmonary vein tissues in patients with paroxysmal focal atrial fibrillation

Chin Feng Tsai, Shih Ann Chen, Ching Tai Tai, Chuen Wang Chiou, V. S. Prakash, Wen Chung Yu, Ming Hsiung Hsieh, Yu An Ding, Mau Song Chang

研究成果: 雜誌貢獻文章

66 引文 (Scopus)

摘要

Introduction: Information is lacking about the occurrence of ablation- related proarrhythmic events during application of radiofrequency (RF) energy at the pulmonary veins in patients with paroxysmal focal atrial fibrillation. The purpose of this study was to assess the theoretical risk of reflex bradycardia and hypotension response during RF ablation of these regions rich in endocardial nerve terminals. Methods and Results: Among the 40 consecutive patients (29 men, 11 women; mean age 65 ± 12 years) with clinically documented frequent attacks of paroxysmal atrial fibrillation who underwent superior pulmonary vein ablation for left focal atrial fibrillation, 6 patients (15%) developed bradycardia-hypotension syndrome during energy delivery. A single atrial fibrillation trigger focus in the left or right superior pulmonary vein was found in 3 and 1 patients, respectively. Two patients had two trigger foci originating from the orifice or proximal part of both superior pulmonary veins. After RF current was applied for a period of 14 ± 10 seconds, 2 patients developed junctional rhythm and sinus bradycardia, another 2 patients had profound sinus bradycardia, 1 patient had two episodes of sudden onset of complete AV block with resultant 9.5-second asystole, and 1 patient showed profound sinus bradycardia, transient AV block, and an 8-second asystole due to sinus arrest. Blood pressure fell when any substantial bradyarrhythmias occurred. All 6 patients were free of rhythm disturbances during the postablation follow-up period (mean 8 ± 2 months). Conclusion: RF catheter ablation of the pulmonary vein tissues could evoke a variety of profound bradycardia-hypotension responses. The Bezold-Jarisch- like reflex might be the underlying mechanism.
原文英語
頁(從 - 到)27-35
頁數9
期刊Journal of Cardiovascular Electrophysiology
10
發行號1
出版狀態已發佈 - 1999
對外發佈Yes

指紋

Pulmonary Veins
Atrial Fibrillation
Reflex
Bradycardia
Hypotension
Atrioventricular Block
Heart Arrest
Catheter Ablation
Blood Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

引用此文

Bezold-Jarisch-like reflex during radiofrequency ablation of the pulmonary vein tissues in patients with paroxysmal focal atrial fibrillation. / Tsai, Chin Feng; Chen, Shih Ann; Tai, Ching Tai; Chiou, Chuen Wang; Prakash, V. S.; Yu, Wen Chung; Hsieh, Ming Hsiung; Ding, Yu An; Chang, Mau Song.

於: Journal of Cardiovascular Electrophysiology, 卷 10, 編號 1, 1999, p. 27-35.

研究成果: 雜誌貢獻文章

Tsai, Chin Feng ; Chen, Shih Ann ; Tai, Ching Tai ; Chiou, Chuen Wang ; Prakash, V. S. ; Yu, Wen Chung ; Hsieh, Ming Hsiung ; Ding, Yu An ; Chang, Mau Song. / Bezold-Jarisch-like reflex during radiofrequency ablation of the pulmonary vein tissues in patients with paroxysmal focal atrial fibrillation. 於: Journal of Cardiovascular Electrophysiology. 1999 ; 卷 10, 編號 1. 頁 27-35.
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abstract = "Introduction: Information is lacking about the occurrence of ablation- related proarrhythmic events during application of radiofrequency (RF) energy at the pulmonary veins in patients with paroxysmal focal atrial fibrillation. The purpose of this study was to assess the theoretical risk of reflex bradycardia and hypotension response during RF ablation of these regions rich in endocardial nerve terminals. Methods and Results: Among the 40 consecutive patients (29 men, 11 women; mean age 65 ± 12 years) with clinically documented frequent attacks of paroxysmal atrial fibrillation who underwent superior pulmonary vein ablation for left focal atrial fibrillation, 6 patients (15{\%}) developed bradycardia-hypotension syndrome during energy delivery. A single atrial fibrillation trigger focus in the left or right superior pulmonary vein was found in 3 and 1 patients, respectively. Two patients had two trigger foci originating from the orifice or proximal part of both superior pulmonary veins. After RF current was applied for a period of 14 ± 10 seconds, 2 patients developed junctional rhythm and sinus bradycardia, another 2 patients had profound sinus bradycardia, 1 patient had two episodes of sudden onset of complete AV block with resultant 9.5-second asystole, and 1 patient showed profound sinus bradycardia, transient AV block, and an 8-second asystole due to sinus arrest. Blood pressure fell when any substantial bradyarrhythmias occurred. All 6 patients were free of rhythm disturbances during the postablation follow-up period (mean 8 ± 2 months). Conclusion: RF catheter ablation of the pulmonary vein tissues could evoke a variety of profound bradycardia-hypotension responses. The Bezold-Jarisch- like reflex might be the underlying mechanism.",
keywords = "Ablation, Bradycardia, Focal atrial fibrillation, Pulmonary vein",
author = "Tsai, {Chin Feng} and Chen, {Shih Ann} and Tai, {Ching Tai} and Chiou, {Chuen Wang} and Prakash, {V. S.} and Yu, {Wen Chung} and Hsieh, {Ming Hsiung} and Ding, {Yu An} and Chang, {Mau Song}",
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T1 - Bezold-Jarisch-like reflex during radiofrequency ablation of the pulmonary vein tissues in patients with paroxysmal focal atrial fibrillation

AU - Tsai, Chin Feng

AU - Chen, Shih Ann

AU - Tai, Ching Tai

AU - Chiou, Chuen Wang

AU - Prakash, V. S.

AU - Yu, Wen Chung

AU - Hsieh, Ming Hsiung

AU - Ding, Yu An

AU - Chang, Mau Song

PY - 1999

Y1 - 1999

N2 - Introduction: Information is lacking about the occurrence of ablation- related proarrhythmic events during application of radiofrequency (RF) energy at the pulmonary veins in patients with paroxysmal focal atrial fibrillation. The purpose of this study was to assess the theoretical risk of reflex bradycardia and hypotension response during RF ablation of these regions rich in endocardial nerve terminals. Methods and Results: Among the 40 consecutive patients (29 men, 11 women; mean age 65 ± 12 years) with clinically documented frequent attacks of paroxysmal atrial fibrillation who underwent superior pulmonary vein ablation for left focal atrial fibrillation, 6 patients (15%) developed bradycardia-hypotension syndrome during energy delivery. A single atrial fibrillation trigger focus in the left or right superior pulmonary vein was found in 3 and 1 patients, respectively. Two patients had two trigger foci originating from the orifice or proximal part of both superior pulmonary veins. After RF current was applied for a period of 14 ± 10 seconds, 2 patients developed junctional rhythm and sinus bradycardia, another 2 patients had profound sinus bradycardia, 1 patient had two episodes of sudden onset of complete AV block with resultant 9.5-second asystole, and 1 patient showed profound sinus bradycardia, transient AV block, and an 8-second asystole due to sinus arrest. Blood pressure fell when any substantial bradyarrhythmias occurred. All 6 patients were free of rhythm disturbances during the postablation follow-up period (mean 8 ± 2 months). Conclusion: RF catheter ablation of the pulmonary vein tissues could evoke a variety of profound bradycardia-hypotension responses. The Bezold-Jarisch- like reflex might be the underlying mechanism.

AB - Introduction: Information is lacking about the occurrence of ablation- related proarrhythmic events during application of radiofrequency (RF) energy at the pulmonary veins in patients with paroxysmal focal atrial fibrillation. The purpose of this study was to assess the theoretical risk of reflex bradycardia and hypotension response during RF ablation of these regions rich in endocardial nerve terminals. Methods and Results: Among the 40 consecutive patients (29 men, 11 women; mean age 65 ± 12 years) with clinically documented frequent attacks of paroxysmal atrial fibrillation who underwent superior pulmonary vein ablation for left focal atrial fibrillation, 6 patients (15%) developed bradycardia-hypotension syndrome during energy delivery. A single atrial fibrillation trigger focus in the left or right superior pulmonary vein was found in 3 and 1 patients, respectively. Two patients had two trigger foci originating from the orifice or proximal part of both superior pulmonary veins. After RF current was applied for a period of 14 ± 10 seconds, 2 patients developed junctional rhythm and sinus bradycardia, another 2 patients had profound sinus bradycardia, 1 patient had two episodes of sudden onset of complete AV block with resultant 9.5-second asystole, and 1 patient showed profound sinus bradycardia, transient AV block, and an 8-second asystole due to sinus arrest. Blood pressure fell when any substantial bradyarrhythmias occurred. All 6 patients were free of rhythm disturbances during the postablation follow-up period (mean 8 ± 2 months). Conclusion: RF catheter ablation of the pulmonary vein tissues could evoke a variety of profound bradycardia-hypotension responses. The Bezold-Jarisch- like reflex might be the underlying mechanism.

KW - Ablation

KW - Bradycardia

KW - Focal atrial fibrillation

KW - Pulmonary vein

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