Taipei Medical University Institutional Repository:Item 987654321/3151
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    Please use this identifier to cite or link to this item: http://libir.tmu.edu.tw/handle/987654321/3151


    Title: The role of left atrial muscular bundles in catheter ablation of atrial fibrillation.
    Authors: 陳亦仁
    Chang SL;Tai CT;Lin YJ;Wongcharoen W;Lo LW;Lee KT;Chang SH;Tuan TC;Chen YJ;Hsieh MH;Tsao HM;Wu MH;Sheu MH;Chang CY;Chen SA.
    Contributors: 臨床醫學研究所
    Date: 2007
    Issue Date: 2009-08-21 16:59:07 (UTC+8)
    Abstract: OBJECTIVES: We sought to investigate the imaging of the left atrial (LA) muscular bundle and the relationship between the bundle and inducibility of tachyarrhythmia after pulmonary vein isolation (PVI). BACKGROUND: Noninducibility is used as a clinical end point of atrial substrate ablation after PVI. However, little is known about the role of the LA muscular bundles in tachyarrhythmia after PVI. METHODS: Forty-three consecutive patients with paroxysmal atrial fibrillation who underwent catheter ablation were included. Bi-atrial isochronal mapping was performed with the NavX system (St. Jude Medical Inc., St. Paul, Minnesota) during sinus rhythm. After 4 PVI, inducible organized LA flutter with or without transforming to atrial fibrillation (AF) (LA flutter/AF) was ablated with additional lines at the roof and/or mitral isthmus. RESULTS: The existence of bilateral muscular bundles was an independent predictor of LA flutter/AF after PVI (p = 0.02). Patients with LA flutter/AF after PVI had a greater index of the double potentials (5.4 +/- 3.4% vs. 2.8 +/- 1.8%, p = 0.006) and interpotential interval (33 +/- 5 ms vs. 29 +/- 4 ms, p = 0.02) than without LA flutter/AF. The muscular bundles were identified in 28% patients using 16-slice multidetector computed tomography, which were identical to the isochrone map. Patients with noninducible LA flutter/AF after PVI plus the additional linear ablation had a lower recurrence rate as compared with the patients without it (19% vs. 75%, p = 0.02). CONCLUSIONS: Left atrial muscular bundles may provide a conduction block line and barrier, which is important for the formation of LA flutter/AF after PVI. The noninducibility of LA flutter/AF achieved after additional linear ablation may contribute to a better outcome in RF ablation of paroxysmal atrial fibrillation.
    Relation: J Am Coll Cardiol.(50):964-973.
    Data Type: article
    Appears in Collections:[Graduate Institute of Clinical Medicine] Periodical Article

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