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1 Chin J Cardiol, March 2004, Vol. 32 No ( ) 4 (HRA) (CS), 10 (Lasso ),, 4 (3 ) (1 ), 118,3,1, 417, ; ; The electrophysiological characteristics and ablation treatment of patients with paroxysmal sustained atrial fibrillation caused by rapid focal activation originating from the pulmonary veinsjiang Hong, HUANG Cong2xin, TANG Qi2zhu, YANG Bo, WANG Xiao2hong, LIU Hua2fen. Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan , China Abstract Objective To report the electrophysiological characteristics and ablation treatment of four patients with sustained atrial fibrillation originating from pulmonary veins. Methods Four patients with frequent episodes and ECG recording of atrial fibrillation were involved in this study. Two multiple electrode catheters were placed in the high right atrium ( HRA) and coronary sinus (CS) for mapping and stimulation. Two decapolar ring2 designed catheters (Lasso mapping catheter, Cordis Co) were positioned into the pulmonary veins ( PV) for mapping of the activation after atrial transseptal puncture and angiography of PV. The cycle length and regularity of the local activation were measured at the bipolar electrograms from HRA, CS and PVs during spontaneous or induced atrial fibrillation. The target pulmonary vein was that where the earliest activity was appeared at the onset of atrial fibrillation or the most irregular activity was recorded during atrial fibrillation. Radiofrequency energy was delivered at the junctions of the target PV and left atrium during atrial fibrillation. The endpoint of procedure was the termination of atrial fibrillation and disappearance of focal activity from PV. Results The rapid focal activation was originated from right superior (3 patients) and left superior (1 patient) PV. Target PV had rapid and irregular activation which had frequent episodes of cycle length shortening. In four patients the atrial fibrillation was terminated during 1 to 18 delivering, and in three of them the rapid activity disappeared at the same time of atrial fibrillation termination. In another patient with the rapid activation from PV during sinus rhythm the focal activity disappeared after PV focal ablation. No recurrence of atrial fibrillation during follow2up of 4 to 17 months. Conclusions It could be concluded that focal activity originated from PV was an important mechanism of paroxysmal atrial fibrillation. Radiofrequency energy ablation to the ostium of target PV could isolate the activity from PV to left atrium or abolish the focal activity to terminate atrial fibrillation. Key words Atrial fibrillation ; Catheter ablation ; Pulmonary veins [1 ], ( ) ( ) : ( ) 转载

2 Chin J Cardiol, March 2004, Vol. 32 No. 3 5 ( 48 ) [2,3 ], 013 g/ d 5 d (3 ) ; 3 INR [4 ] 4 ( HRA) (CS) 8F Swartz SL0 (Dig ), : 4 2, (RIPV) HRA CS, 431, HRA CS (1), 4 d 2 3 ( ),3, 410 cm ( 315 cm), : 2. : (Lasso, Cordis ) (LSPV) (RSPV), 1 Lasso, (LIPV) 3. : APB :,AFL : ;HRA :,CSO :,CSD :, LSPV :,RSPV :,ST: (26 ) ; (2 ) 1 4, LSPV 3,4 LSPV 9,10

3 Chin J Cardiol, March 2004, Vol. 32 No Lasso, (, 6090 s,,, ms, ms,, IBI2T 6, W : (2), CS 2. :4 1 RSPV 1,3, (2 ) (1 ) 115 cm 4, 14 s 1),,14,, (3) (4) 2 4 RSPV LSPV 1. :4, 1 18, RSPV(3 ) LSPV(1 ) 3 4 CS LSPV 2 (2 ) (1 ),1,RSPV 9,10 A : (3 ),P : (6 ) 2 4, LSPV 9,10 LSPV

4 Chin J Cardiol, March 2004, Vol. 32 No. 3 NSR :,SP : (5 ) 3 1, RSPV,, RF on : (5 ) 4 1, ( ), ( ) (5), CS, 7, 3. : (6) 3 RSPV,1 3 4, 11,, CS,3 2 1

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6 Chin J Cardiol, March 2004, Vol. 32 No. 3, 1,3, [, 2 (3 4) [5,6 ], [7,8 ] (sleeves),, [3,5,9 ] 1, : (1) ; (2),,, ; (3),,, [10 ],, 3,2, (Lasso ), [4 ], (1) ;, 5,, [3 ], 4,, atrial fibrillation. Basic Res Cardiol, 2002, 97 :26234.,, 576. ;, ] 1..,2002,6 : Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med, 1998, 339 : Nakashima H, Kumagai K, Noguch H, et al. Evaluation of the recurrence of atrial fibrillation after pulmonary venous ablation. J Cardiol, 2002, 40 : Sanders P, Monton JB, Deen R, et al. Immediated and long2term results of radiofrequency ablation of pulmonary vein ectopy for cure of paroxysmal atrial fibrillation using a focal approach. Intern Med J, 2002, 32 : ,,..,2000,4 : Donnel D, Furniss SS, Bounke JR, et al. Paroxysmal cyde length shortening in the pulmonary veins during atrial fibrillation correlated with arrhythmgenic triggering foci in sinus rhythm. J Cardiovasc Electrophysiol, 2002, 13 : Nathan H, Gloobe H. Myocardial atrio2venous junctions and extension (sleeves) over the pulmonary and caval veins : anatomical observation in varior mammals. Thorax, 1970, 25 : Chen YJ, Chen SA, Chen YC, et al. Electrophysiology of single cariomyocytes isolated from rabbit pulmonary veins : implication of focal 9 Jais P, Haissaguerre M, Shah DC. A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation, 1997, 95 : Mangrum JM, Mounsey JP, Kok LC, et al. Intracardiac echocardiography2guided anatomical based radiofrequency ablation of focal atrial fibrillation originating from pulmonary veins. J Am Coll Cardiol, 2002, 39 : ( : ) 4 ( : )