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Netherlands Heart Journal logoLink to Netherlands Heart Journal
. 2002 May;10(5):241–244.

Technique of pulmonary vein isolation by catheter ablation

FHM Wittkampf, R Derksen, EFD Wever, TA Simmers, LVA Boersma, EPA Vonken, BK Velthuis, N Sreeram, BJ Rensing, MJ Cramer
PMCID: PMC2499711  PMID: 25696100

Abstract

In selected patients with atrial fibrillation, the fibrillation episodes may be initiated by single or short bursts of ectopy often originating from one or more pulmonary veins (PVs). Therefore, electrical isolation of these veins by catheter ablation is currently being explored as a treatment modality for patients with paroxysmal and even more permanent types of atrial fibrillation. At present, two different techniques are used: 1) selective ablation of electrical connections between left atrium and myocardial sleeves inside the PVs; and 2) contiguous encircling lesions around and outside the PV ostia. With both techniques, moderate to high success rates have been reported with a limited follow-up duration. Both types of procedure are very complex and require a highly skilful team. With the variable anatomy of the PVs, non-invasively acquired angiographic images may serve as a roadmap for catheter manipulation. Modern three-dimensional catheter navigation techniques can be applied to facilitate accurate catheter positioning with limited fluoroscopic exposure. Experimental and clinical research is needed to define patient selection criteria.

Keywords: atrial fibrillation, pulmonary veins, catheter ablation

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Gerstenfeld E. P., Guerra P., Sparks P. B., Hattori K., Lesh M. D. Clinical outcome after radiofrequency catheter ablation of focal atrial fibrillation triggers. J Cardiovasc Electrophysiol. 2001 Aug;12(8):900–908. doi: 10.1046/j.1540-8167.2001.00900.x. [DOI] [PubMed] [Google Scholar]
  2. Haïssaguerre M., Jaïs P., Shah D. C., Takahashi A., Hocini M., Quiniou G., Garrigue S., Le Mouroux A., Le Métayer P., Clémenty J. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998 Sep 3;339(10):659–666. doi: 10.1056/NEJM199809033391003. [DOI] [PubMed] [Google Scholar]
  3. Haïssaguerre M., Shah D. C., Jaïs P., Hocini M., Yamane T., Deisenhofer I., Chauvin M., Garrigue S., Clémenty J. Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation. 2000 Nov 14;102(20):2463–2465. doi: 10.1161/01.cir.102.20.2463. [DOI] [PubMed] [Google Scholar]
  4. Hocini M., Shah D. C., Jaïs P., Haïssaguerre M., Peng J. T., Yamane T., Deisenhofer I., Garrigue S., Clémenty J. Concealed left pulmonary vein potentials unmasked by left atrial stimulation. Pacing Clin Electrophysiol. 2000 Nov;23(11 Pt 2):1832–1835. doi: 10.1111/j.1540-8159.2000.tb07031.x. [DOI] [PubMed] [Google Scholar]
  5. Moak J. P., Moore H. J., Lee S. W., Giglia T. M., Sable C. A., Furbush N. C., Ringel R. R. Case report: pulmonary vein stenosis following RF ablation of paroxysmal atrial fibrillation: successful treatment with balloon dilation. J Interv Card Electrophysiol. 2000 Dec;4(4):621–631. doi: 10.1023/a:1026573816874. [DOI] [PubMed] [Google Scholar]
  6. Oral Hakan, Knight Bradley P., Tada Hiroshi, Ozaydin Mehmet, Chugh Aman, Hassan Sohail, Scharf Christoph, Lai Steve W. K., Greenstein Radmira, Pelosi Frank., Jr Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation. 2002 Mar 5;105(9):1077–1081. doi: 10.1161/hc0902.104712. [DOI] [PubMed] [Google Scholar]
  7. Pappone C., Oreto G., Rosanio S., Vicedomini G., Tocchi M., Gugliotta F., Salvati A., Dicandia C., Calabrò M. P., Mazzone P. Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation. 2001 Nov 20;104(21):2539–2544. doi: 10.1161/hc4601.098517. [DOI] [PubMed] [Google Scholar]
  8. Pappone C., Rosanio S., Oreto G., Tocchi M., Gugliotta F., Vicedomini G., Salvati A., Dicandia C., Mazzone P., Santinelli V. Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation. Circulation. 2000 Nov 21;102(21):2619–2628. doi: 10.1161/01.cir.102.21.2619. [DOI] [PubMed] [Google Scholar]
  9. Ramanna H., Hauer R. N., Wittkampf F. H., de Bakker J. M., Wever E. F., Elvan A., Robles De Medina E. O. Identification of the substrate of atrial vulnerability in patients with idiopathic atrial fibrillation. Circulation. 2000 Mar 7;101(9):995–1001. doi: 10.1161/01.cir.101.9.995. [DOI] [PubMed] [Google Scholar]
  10. Saito T., Waki K., Becker A. E. Left atrial myocardial extension onto pulmonary veins in humans: anatomic observations relevant for atrial arrhythmias. J Cardiovasc Electrophysiol. 2000 Aug;11(8):888–894. doi: 10.1111/j.1540-8167.2000.tb00068.x. [DOI] [PubMed] [Google Scholar]
  11. Wittkampf F. H., Wever E. F., Derksen R., Wilde A. A., Ramanna H., Hauer R. N., Robles de Medina E. O. LocaLisa: new technique for real-time 3-dimensional localization of regular intracardiac electrodes. Circulation. 1999 Mar 16;99(10):1312–1317. doi: 10.1161/01.cir.99.10.1312. [DOI] [PubMed] [Google Scholar]
  12. van Hemel N. M., Defauw J. J., van Swieten H. A., Vermeulen F. E., Kingma J. H. Surgical treatment of atrial fibrillation. J Thorac Cardiovasc Surg. 1992 Nov;104(5):1491–1494. [PubMed] [Google Scholar]

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