Skip to main content
SpringerLink
Log in

Segmental pulmonary vein isolation in atrial fibrillation: new insights from the high density mesh mapper technique in an electrophysiologically guided approach

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Objective

As opposed to fundamental investigations into the nature of atrial fibrillation (AF) current clinical studies of AF ablation techniques sometimes only contain sparse information about the underlying electrophysiological properties. The purpose of this prospective, pilot study was to evaluate acute therapeutic success and clinical outcome after 6 month of segmental ostial ablation (SOA) using the High Density Mesh Mapper catheter (HDMM, BARD Electrophysiology, Lowell, MA, USA) for an electrophysiological guided approach. The HDMM is a novel, single expandable basket electrode catheter for high resolution recordings at the left atrium/pulmonary vein (PV) junction.

Methods

SOA was performed by irrigated radiofrequency (RF) application around the HDMM. Entry- and exit conduction block, as well as decreased local electrode amplitude, were endpoints for short-term successful ablation.

Results

Seventy-two patients with highly symptomatic paroxysmal AF (PAF; 47, 65.2%), persistent AF (12, 16.7%) and permanent AF (13, 18.1%) were studied. Entrance conduction block was obtained in 93%, exit conduction block in 81% of all PV. After 6 month no PV stenosis was observed, 62 patients (86.1%) improved clinically, whereas 52 patients (72.2%) were free from arrhythmias and sinus rhythm was present favoring patients with PAF.

Conclusions

In this first prospective study of PV isolation using the HDMM, our findings suggest, that this method is safe and yields good primary success rates and favourable clinical outcome at 6 month. The new technology based on high resolution recordings, offers beside good anatomical orientation a direct electrophysiological control for monitoring of bidirectional conduction block.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

AF:

Atrial Fibrillation

CCL:

Continuous Circular Lesions

HDMM:

High Density Mesh Mapper

LIPV:

Left Inferior Pulmonary Vein

LSPV:

Left Superior Pulmonary Vein

PAF:

Paroxysmal AF

PV:

Pulmonary Vein(s)

RF:

Radio Frequency

RIPV:

Right Inferior Pulmonary Vein

RSPV:

Right Superior Pulmonary Vein

SOA:

Segmental Ostial Ablation

References

  1. Haïssaguerre, M., Jaïs, P., Shah, D., Takahashi, A., Hocini, M., Quiniou, G., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. The New England Journal of Medicine, 339, 659–666.

    Article  PubMed  Google Scholar 

  2. Oral, H., Knight, B. P., Tada, H., Özaydin, M., Chugh, A., Hassan, S., et al. (2002). Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation, 105, 1077–1081.

    Article  PubMed  Google Scholar 

  3. Pappone, C., Oreto, G., Rosanio, S., Vicedomini, G., Tocchi, M., Gugliotta, F., et al. (2001). Atrial electroanatomical remodeling after circumferential radiofrequency pulmonary vein isolation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation, 104, 2539–2254.

    Article  PubMed  CAS  Google Scholar 

  4. Cox, J. L., Boineau, J. P., Schuessler, R. B., Krater, K. M., & Lappas, D. G. (1993). Five year experience with the Maze procedure for atrial fibrillation. The Annals of Thoracic Surgery, 56, 814–824.

    Article  PubMed  CAS  Google Scholar 

  5. Meissner, A., Christ, M., Maagh, P., Borchard, R., van Bracht, M., Wickenbrock, I., et al. (2007). Quality of life and occurrence of atrial fibrillation in long term follow up of common type atrial flutter: Ablation with irrigated 5 mm tip- and conventional 8 mm tip electrode. Clinical Research in Cardiology; Official Journal of the German Cardiac Society, 96, 794–802.

    PubMed  Google Scholar 

  6. Haïssaguerre, M., Shah, D., Jaïs, P., Hocini, M., Yamane, T., Deisenhofer, I., et al. (2000). Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation, 102, 2463–2465.

    PubMed  Google Scholar 

  7. Marrouche, N. F., Dresing, N. F., Cole, C., Bash, D., Saad, E., Balaban, K., et al. (2002). Circular mapping and ablation of the pulmonary veins for treatment of atrial fibrillation: impact of different catheter techniques. Journal of the American College of Cardiology, 40, 464–474.

    Article  PubMed  Google Scholar 

  8. Takahashi, A., Iesaka, Y., Takahashi, Y., Takahashi, R., Kobayashi, K., Takagi, K., et al. (2002). Electrical connections between pulmonary veins: implication for ostial ablation of pulmonary veins in patients with atrial fibrillation. Circulation, 105, 2998–3003.

    Article  PubMed  Google Scholar 

  9. Oral, H., Scharf, C., Chugh, A., Hall, B., Cheung, P., Good, E., et al. (2003). Catheter ablation for paroxysmal atrial fibrillation. Segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation, 108, 2355–2360.

    Article  PubMed  Google Scholar 

  10. Karch, M. R., Zrenner, B., Deisenhofer, I., Schreieck, J., Ndrepepa, G., Dong, J., et al. (2005). Freedom of atrial tachyarrhythmias after catheter ablation of atrial fibrillation: A randomized comparison between 2 current ablation strategies. Circulation, 111, 2875–2880.

    Article  PubMed  Google Scholar 

  11. Ouyang, F., Bänsch, D., Ernst, S., Schaumann, A., Hachiya, H., Chen, M., et al. (2004). Complete Isolation of left atrium surrounding the pulmonary veins. New insights from the double-lasso technique in paroxysmal atrial fibrillation. Circulation, 110, 2090–2096.

    Article  PubMed  Google Scholar 

  12. Arrudo, M. S., He, D. S., Sheng, D., Friedmann, P., Nakagawa, H., Bruce, C., et al. (2007). A novel mesh electrode catheter for mapping and radiofrequency delivery at the left atrium-pulmonary vein junction: A single-catheter approach to pulmonary vein antrum isolation. Journal of Cardiovascular Electrophysiology, 18, 206–211.

    Article  Google Scholar 

  13. Ott, P., Kirk, M. M., Koo, C., Sheng, D., Bhattacharya, B., & Buxton, A. (2007). Coronary sinus and fossa ovalis ablation: Effect on interatrial conduction and atrial fibrillation. Journal of Cardiovascular Electrophysiology, 18, 1–8.

    Article  Google Scholar 

  14. Ernst, S., Ouyang, F., Löber, F., Antz, M., & Kuck, K. H. (2003). Catheter induced linear lesions in the left atrium in patients with atrial fibrillation. Journal of the American College of Cardiology, 42, 1271–1282.

    Article  PubMed  Google Scholar 

  15. Hocini, M., Sanders, P., Jais, P., Hsu, L. F., Weerasoriya, R., Scavée, C., et al. (2005). Prevalence of pulmonary vein disconnection after anatomical ablation for atrial fibrillation: consequences of wide atrial encircling of the pulmonary veins. European Heart Journal, 26, 696–704.

    Article  PubMed  Google Scholar 

  16. Nademanee, K., Mc Kenzie, J., Kosar, E., Schwab, M., Sunsaneewitayakul, B., Vasavakul, C., et al. (2004). A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiological substrate. Journal of the American College of Cardiology, 43, 2044–2053.

    Article  PubMed  Google Scholar 

  17. Chen, S. A., Hsiech, M. H., Tai, C. T., Tsai, C. F., Yu, W. C., Hsu, T. L., et al. (1999). Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: electrophysiological characteristics, pharmacological response, and effects of radiofrequency ablation. Circulation, 100, 1879–1886.

    PubMed  CAS  Google Scholar 

  18. Haïssaguerre, M., Jaïs, P., Shah, D. C., Garrigue, S., Takahashi, A., Lavergne, T., et al. (2000). Electrophysiological endpoint for catheter ablation of atrial fibrillation initiated from multiple pulmonary vein foci. Circulation, 101, 1409–1417.

    PubMed  Google Scholar 

  19. Jaïs, P., Hocini, M., Macale, L., Choi, H. J., Deisenhofer, I., Weerasooriya, R., et al. (2002). Distinctive electrophysiological properties of pulmonary veins in patients with atrial fibrillation. Circulation, 206, 2479–2485.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology and Angiology, Ruhr-University Bochum, Bochum, Germany

    Axel Meissner, Marc van Bracht, Max-Olav Schrage, Martin Christ, Hans-Joachim Trappe, Petra Maagh, Thomas Butz & Gunnar Plehn

  2. Medizinische Klinik II, Schwerpunkte Kardiologie und Angiologie, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany

    Axel Meissner

  3. Department of Cardiology and Angiology, Marienhospital Lünen, Lünen, Germany

    Christian-Andreas Perings

Authors
  1. Axel Meissner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc van Bracht
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Max-Olav Schrage
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Christ
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hans-Joachim Trappe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Petra Maagh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christian-Andreas Perings
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thomas Butz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gunnar Plehn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Axel Meissner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Meissner, A., van Bracht, M., Schrage, MO. et al. Segmental pulmonary vein isolation in atrial fibrillation: new insights from the high density mesh mapper technique in an electrophysiologically guided approach. J Interv Card Electrophysiol 25, 183–192 (2009). https://doi.org/10.1007/s10840-009-9365-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-009-9365-z

Keywords

Search

Navigation