Abstract:
OBJECTIVES:To evaluate the feasibility and outcome of ablation to transect the anterior left atrium (LA) in patients with atrial fibrillation (AF). BACKGROUND:While the Maze procedure is effective in maintaining sinus rhythm in patients with AF, it is associated with significant morbidity. This prospective clinical study evaluates the feasibility and consequences of limited LA linear ablation to transect the anterior LA in patients with AF. METHODS:Twenty-four patients (51.2 +/- 7.3 years) with paroxysmal (n = 16) or chronic (n = 8) AF resistant to pulmonary vein (PV) isolation were studied. To transect the anterior LA, linear ablation was performed joining the superior PVs; this line was then connected to the anterior mitral annulus. Pulmonary vein isolation and cavotricuspid isthmus ablation were performed in all cases. Ablation was performed using an irrigated catheter with the endpoint of achieving complete linear block demonstrated by online double potentials, differential pacing techniques, and an activation detour. RESULTS:Of 20 patients in AF prior to linear ablation, arrhythmia terminated in 12 (60%), including half the patients with chronic AF, during ablation. Despite repeated ablation, complete linear block was achieved in only 14 of 24 patients (58%). Complete linear conduction block resulted in an activation detour around the mitral annulus and PVs with a delay of 158 +/- 30 ms (P = .0001), significantly delayed activation of the lateral LA with prolongation of P-wave duration (P = .002), and characteristic change in P-wave morphology during sinus rhythm (P = .002). Of the 14 with anterior LA transection, 4 (29%) have had regular atrial tachycardias due to macroreentry through recovered gaps. Nine of these 14 (64%) have remained arrhythmia-free without antiarrhythmics compared to 3 of 10 (30%) with incomplete block at 28 +/- 4 months following their last procedure (P = .2). CONCLUSIONS:This study demonstrates the feasibility of catheter ablation to transect the anterior LA in humans. While being effective in the termination of AF, this configuration of linear lesions is technically challenging to complete, results in significant delayed LA activation, and is associated with modest long-term arrhythmia suppression.
journal_name
Heart Rhythmjournal_title
Heart rhythmauthors
Sanders P,Jaïs P,Hocini M,Hsu LF,Scavée C,Sacher F,Rotter M,Takahashi Y,Pasquié JL,Shah DC,Garrigue S,Clémenty J,Haïssaguerre Mdoi
10.1016/j.hrthm.2004.03.072keywords:
subject
Has Abstractpub_date
2004-07-01 00:00:00pages
176-84issue
2eissn
1547-5271issn
1556-3871pii
S154752710400102Xjournal_volume
1pub_type
杂志文章相关文献
HEART RHYTHM文献大全abstract:BACKGROUND:Prolonged Tpeak-end (the interval from the peak of the T wave to the end of the T wave) and Tpeak-end/QT ratio have been shown to be markers of arrhythmogenesis in various cardiac disorders. OBJECTIVES:The purpose of this study was to evaluate the utility of Tpeak-end and Tpeak-end/QT ratio at admission in ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2014.11.034
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Ablation of long-standing persistent atrial fibrillation (AF) is highly variable, with differing techniques and outcomes. OBJECTIVE:The purpose of this study was to undertake a systematic review of the literature with regard to the impact of ablation technique on the outcomes of long-standing persistent AF ...
journal_title:Heart rhythm
pub_type: 杂志文章,评审
doi:10.1016/j.hrthm.2010.01.017
更新日期:2010-06-01 00:00:00
abstract:BACKGROUND:Ventricular arrhythmias (VAs) in cardiac sarcoidosis (CS) are frequently refractory to both antiarrhythmic drug (AAD) therapy and catheter ablation (CA). Cardiac sympathetic denervation (CSD) has been shown to reduce VA burden and implantable cardioverter-defibrillator (ICD) shocks in patients with nonischem...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2019.02.025
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:The extent of left atrial (LA) late gadolinium enhancement (LGE), as a surrogate for fibrosis, has been associated with atrial fibrillation (AF) recurrence after catheter ablation. Furthermore, there is ex vivo evidence that islands of fibrosis may anchor fibrillatory rotors. OBJECTIVE:The purpose of this s...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2015.11.011
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:Although heart failure (HF) is closely associated with susceptibility to sudden cardiac death (SCD), the mechanisms linking contractile dysfunction to cardiac electrical instability are poorly understood. Cardiac alternans has also been closely associated with SCD, and has been linked to a mechanism for ampl...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2008.11.008
更新日期:2009-02-01 00:00:00
abstract::Understanding of the mechanisms underlying atrial fibrillation (AF) remain limited. However, both persistent and paroxysmal AF likely initiate via the interaction of triggers such as premature atrial beats with 'substrate', that includes static components such as fibrosis and scar, as well as dynamic alterations that ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2009.03.004
更新日期:2009-08-01 00:00:00
abstract:BACKGROUND:Myocardial fibrosis (macroscopic scar or diffuse reactive fibrosis) is one of the determinants of impaired left ventricular (LV) global longitudinal strain (GLS) in heart failure (HF) patients. OBJECTIVE:The purpose of this study was to evaluate the prognostic value of LV GLS in HF patients treated with car...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2018.03.034
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:P wave indices are an intermediate phenotype modulated by atrial conduction and electrophysiology. Their clinical correlates and association with all-cause mortality have received limited scrutiny. OBJECTIVE:To determine the relationship between P wave indices and cardiovascular and all-cause mortality in t...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2010.09.020
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Atrial fibrillation (AF) is the most encountered arrhythmia and has been associated with worse in-hospital outcomes. OBJECTIVE:To determine the incidence of AF among patients hospitalized with COVID-19 as well as its impact on in-hospital mortality. METHODS:Patients hospitalized with a positive COVID-19 po...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2021.01.018
更新日期:2021-01-22 00:00:00
abstract:BACKGROUND:Premature ventricular complex (PVC) ablation has been shown to improve left ventricular ejection fraction (LVEF) and New York Heart Association functional class in patients with left ventricular dysfunction. Both are considered key variables in predicting risk of sudden cardiac death. OBJECTIVE:The objectiv...
journal_title:Heart rhythm
pub_type: 杂志文章,多中心研究
doi:10.1016/j.hrthm.2015.09.011
更新日期:2015-12-01 00:00:00
abstract::Newer generations of pacemakers and implantable cardioverter defibrillators have enhanced diagnostic features that permit detection and storage of information about the frequency, duration, time of onset, and rate characteristics of multiple consecutive episodes of atrial tachycardia and atrial fibrillation (AF). Para...
journal_title:Heart rhythm
pub_type: 杂志文章,评审
doi:10.1016/j.hrthm.2004.03.075
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND:Enhanced dispersion of action potential duration (APD) is a major contributor to long QT syndrome (LQTS)-related arrhythmias. OBJECTIVE:To investigate spatial correlations of regional heterogeneities in cardiac repolarization and mechanical function in LQTS. METHODS:Female transgenic LQTS type 2 (LQT2; n =...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2013.07.038
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:Nontransvenous (NTV) implantable cardioverter-defibrillator (ICD) systems with pericardial and/or subcutaneous coils are used in select pediatric and congenital heart disease patients who are not candidates for transvenous ICD leads. Outcomes with these hybrid configurations are not well understood. OBJECTI...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2009.10.014
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:We previously showed that omega-3 polyunsaturated fatty acids (PUFAs) reduce vulnerability to atrial fibrillation (AF). The mechanisms underlying this effect are unknown. OBJECTIVE:The purpose of this study was to use a genome-wide approach to identify gene expression profiles involved in a new model of AF ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2009.12.016
更新日期:2010-04-01 00:00:00
abstract:BACKGROUND:Although consensus documents on catheter and surgical ablation of atrial fibrillation (AF) suggest a uniform "blanking period" of 3 months, recent evidence suggested that early recurrences of atrial tachyarrhythmias (ERATs) are strongly associated with late recurrences (LRs), especially if ERATs occurred in ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2015.12.034
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Arrhythmogenic right ventricular cardiomyopathy (ARVC) has been linked to mutations in desmosomal proteins, including plakophilin-2 (PKP2). Little is known about the changes in cellular function and structure that follow expression of ARVC-relevant PKP2 mutations. OBJECTIVE:The purpose of this study was to ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2008.09.009
更新日期:2008-12-01 00:00:00
abstract:BACKGROUND:The slow and rapid (I(Kr)) components of I(K) are major determinants of ventricular repolarization. Unlike I(Kr), which is homogeneously expressed across the transmural wall, I(Ks) expression is reduced in midmyocardial cells and presumably contributes significantly to transmural dispersion of repolarization...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2005.04.015
更新日期:2005-07-01 00:00:00
abstract:BACKGROUND:Left atrial appendage (LAA) has recently been of significant focus because of the development of the LAA closure device. OBJECTIVE:The purpose of this study was to test the hypothesis that atrial fibrillation (AF) leads to a morphologic change in the LAA and to investigate the characteristics of LAA morphol...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2016.06.009
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:We examined nonprescription weight-loss supplements marketed on the Internet for ingredients with potential arrhythmogenic and life-threatening cardiac adverse effects. OBJECTIVE:We aimed to define the risks of life-threatening cardiac adverse effects that are associated with weight-loss supplements markete...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2009.02.021
更新日期:2009-05-01 00:00:00
abstract:BACKGROUND:Mutations in the RyR2-encoded cardiac ryanodine receptor/calcium release channel and in CASQ2-encoded calsequestrin cause catecholaminergic polymorphic ventricular tachycardia (CPVT1 and CPVT2, respectively). OBJECTIVES:The purpose of this study was to evaluate the extent of genotypic and phenotypic heterog...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2006.03.025
更新日期:2006-07-01 00:00:00
abstract:BACKGROUND:Physicians will increasingly encounter patients who require rhythm management devices but have venous obstructions that prevent conventional access. Alternate access options, such as thoracotomy or transiliac approaches, exist but are associated with greater cost and morbidity. OBJECTIVE:The purpose of this...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2011.01.024
更新日期:2011-06-01 00:00:00
abstract:BACKGROUND:Predictors of risk of lethal arrhythmic events (LAE) is poorly understood and may differ from adults in children with hypertrophic cardiomyopathy (HCM). OBJECTIVE:The purpose of this study was to determine predictors of LAE in children with HCM. METHODS:A retrospective data collection was performed on 446 ...
journal_title:Heart rhythm
pub_type: 杂志文章,多中心研究
doi:10.1016/j.hrthm.2019.04.040
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:In patients with ventricular tachycardia or ventricular fibrillation (VT/VF) electrical storm (ES) undergoing catheter ablation (CA), hypotension due to refractory VT/VF, use of anesthesia, and cardiac stunning due to repeated implantable cardioverter-defibrillator shocks might precipitate acute hemodynamic ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2017.09.005
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:The degree of QT prolongation by drug is highly variable and related to risk for polymorphic ventricular tachycardia due to drugs. OBJECTIVE:The purpose of this study was to determine factors that affect the degree of QT prolongation by drugs. METHODS:QT and QTc were measured before and after administratio...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2011.03.042
更新日期:2011-10-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to identify risk markers in patients with Brugada syndrome. BACKGROUND:Patients with Brugada syndrome who experience syncope or aborted sudden death are at high risk for recurrent lethal arrhythmias. The prognosis and therapeutic approaches in asymptomatic individuals with a Br...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2004.11.022
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:Standard electroanatomic mapping systems use a single catheter to perform left ventricular substrate mapping. A new mapping system uses a 64-electrode mini-basket catheter to perform rapid automated acquisition of chamber geometry, voltage, and activation. OBJECTIVE:The aim of this study was to compare the ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2014.08.036
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:The origin of outflow tract ventricular tachycardia (OTVT) can be predicted from a surface electrocardiogram: indexes of R-wave amplitudes in leads V(1) and V(2) are used to differentiate a right origin from a left origin, while the axis of lead I differentiates an anterior origin from a posterior origin. In...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2011.12.007
更新日期:2012-05-01 00:00:00
abstract:BACKGROUND:Implantable cardioverter-defibrillators monitor intracardiac electrograms (EGMs) to discriminate between ventricular and supraventricular tachycardias. The incidence of inappropriate shocks remains high because of misclassification of the tachycardia in an otherwise hemodynamically stable individual. Couplin...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2014.06.034
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:Prolongation of the PR interval has been associated with an increased risk of incident atrial fibrillation (AF). OBJECTIVE:To determine if there was a nonlinear relation between PR interval duration and the risk of AF. METHODS:We included 288,181 individuals, corresponding to one third of the population in...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2013.04.012
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Pacing in the right ventricle can cause a variety of detrimental effects, including atrial tachyarrhythmias (atrial tachycardia [AT]/atrial fibrillation [AF]). OBJECTIVE:The purpose of this study was to evaluate the incidence and predictors of persistent AT/AF in patients with long-term exposure to ventricu...
journal_title:Heart rhythm
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.hrthm.2015.06.041
更新日期:2015-11-01 00:00:00