Mapping-guided ablation of pulmonary veins to cure atrial fibrillation

Catheter ablation of triggers inducing paroxysms of atrial fibrillation (AF ) is an emerging therapy for this common arrhythmia. In a series of 225 con secutive patients with AF resistant to multiple drugs, 96% presented with t riggering foci originating from 1 or multiple pulmonary veins (PV), indepen dently of whether or not the patient had ectopy or structural heart disease . The present article describes the mapping and ablation techniques applica ble to individual patients: (1) criteria to define an arrhythmogenic PV; (2 ) use of provocative maneuvers; and (3) the role of circumferential mapping catheters to provide extent, distribution, and activation of PV muscle as well as monitoring distal PV potentials (PVP) during ablation. Radiofrequen cy oblation can be performed by targeting the PVP during sinus rhythm (righ t PV) or left atrial pacing (left PV) with the procedural endpoint of PVP e limination, which is more effective in predicting a successful outcome than suppression of acute ectopy. Complete elimination of AF is presently obtai ned in 70% of patients, allowing interruption of arrhythmias and in use ant icoagulants. It is anticipated that continued technologic improvements will improve and facilitate this technique of curative treatment of AF. (C) 200 0 by Excerpta Medica, Inc.