Chronic atrial fibrillation in patients with rheumatic heart disease - Mapping and radiofrequency ablation of flutter circuits seen at initiation after cardioversion
M. Nair et al., Chronic atrial fibrillation in patients with rheumatic heart disease - Mapping and radiofrequency ablation of flutter circuits seen at initiation after cardioversion, CIRCULATION, 104(7), 2001, pp. 802-809
Citations number
22
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-There is little information concerning mapping and radiofrequenc
y ablation (RFA) of arrhythmias seen during reinduction of atrial fibrillat
ion (AF) after pharmacological and/or electrical cardioversion in patients
with chronic AF and rheumatic heart disease.
Methods and Results-Seventeen patients with rheumatic heart disease and sym
ptomatic chronic AF underwent multisite atrial mapping during reinduction o
f AF after cardioversion. An organized atrial arrhythmia of varying duratio
n was seen to precede the AF in all patients. The earliest atrial activity
during this organized rhythm was near the coronary sinus ostium (CS OS) in
14 patients and along the left side of the interatrial septum (IAS) in 3 pa
tients. RFA was performed in 16 patients (14 near the CS OS and 2 along the
IAS). Postablation AF was inducible in I patient in whom RFA was preformed
near the CS OS and in both patients when it was performed alone, the IAS.
At a follow-up of 6 to 56 weeks (mean, 32 weeks), 10 of the 13 patients who
had successful ablation were in sinus rhythm. All patients in whom AF was
reinducible immediately after RFA continue to be in AF.
Conclusions-Induced AF in patients with rheumatic heart disease begins as a
rapid organized arrhythmia with earliest atrial activity near the CS OS in
most patients. RFA targeting the region of the CS OS is successful in supp
ressing the arrhythmia immediately in most of the patients and in most on f
ollow-up.