Focal paroxysmal atrial fibrillation: preliminary results of high-frequency catheter ablations

Background and objective: As has recently been discovered, paroxysmal atria l fibrillation (PAF) can be induced by focal extrasystoles or tachycardia. This raises the question of whether this form of atrial fibrillation can be cured by high-frequency catheter ablation of the focal trigger. Patients and methods: Seven men and eleven women (mean age 45,6 +/- 11 year s) with severe symptoms and treatment-resistant PAF underwent electrophysio logical tests with the aim of high-frequency catheter ablation, if long-ter m ECC monitoring had demonstrated frequent atrial extrasystoles or tachycar dia as pointer to a focal origin. Ablation was performed at the point of ea rliest excitation after the origin of the ectopic focus had been localized. The end-point was reached if the atrial ectopic rhythm had ceased for more than 60 min. Results: In 18 of the 20 patients an ectopic focus was found and successful ly ablated (1 in the superior vena cava, 3 in the right atrium and 16 in a pulmonary vein). Atrial ectopic beats recurred within 24 hours of ablation in 6 of the 14 patients with a pulmonary vein focus: a second focus was fou nd in two; re-emergence of the original focus in two, no re-investigation i n another two. 13 of the 18 patients have had no further symptoms after a m ean follow-up of 11 months without anti-arrhythmia treatment. Conclusion: The results indicate that focally induced paroxysmal atrial fib rillation can be cured by locally applied high-frequency ablation.