Teiichi Yamane — Page 2

PubMed2002

Successful ablation of Hisian ectopy identified by a reversed His bundle activation sequence.

Junctional ectopy or tachycardia have been mapped and ablated in the atrioventricular node or its posterior extensions. There is no report of Hisian ectopy convincingly demonstrated and then successfully treated by ablation. A 39-year-old man presented with a 9-year history of recurrent supraventricular ectopy refractory to medical treatment. Intracardiac mapping revealed that the ectopy originated from the His bundle, which was indicated by a reversed His bundle activation sequence during ectopy compared to that during sinus rhythm, while the right bundle branch potential was anterogradely activated. Low power RF energy delivered to the site of earliest activation completely abolished the ectopic activity without modification of Hisian or atrioventricular conduction. After a 12-month followup, the patient remains free of recurrence.

Adult↗

PubMed2002

Dilatation as a marker of pulmonary veins initiating atrial fibrillation.

BACKGROUND: The pulmonary veins (PVs) have been shown to trigger paroxysmal atrial fibrillation. The relationship of anatomical dimensions versus arrhythmogenicity has not been assessed. METHODS: The diameters of four PVs were measured by selective PV angiography before ablation in 39 consecutive patients (23 male, mean age 46 years) with only one (25 patients) or two (14 patients) arrhythmogenic PVs (ArPVs). After ablation of ArPVs, no patient had recurrence of atrial fibrillation from the remaining PVs. Comparisons were performed variously between ArPV and non-ArPV, and within and across both groups. RESULTS: ArPVs were distributed as follows; left superior PV: 40%, left inferior PV: 28%, right superior PV: 26%, and right inferior PV: 6%. Statistical comparisons showed that (1) Triggers of atrial fibrillation were located in the largest PV in 72% of patients, (2) For each PV, the mean diameter of ArPV was significantly larger than that of non-ArPV (p < 0.05), (3) No significant difference was observed in the diameter of the four different ArPVs (range 16.2 +/- 1.3 to 17.2 +/- 4.4). CONCLUSIONS: In patients with atrial fibrillation initiated from one or two ArPVs, the diameters of ArPVs were significantly larger than those of non-ArPVs irrespective of the specific PV concerned, which might imply a possible role of PV dilatation in the arrhythmogenesis.

Adult↗