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Lasso Catheter (lasso + catheter)
Selected AbstractsATP-Induced Dormant Pulmonary Veins Originating from the Carina Region After Circumferential Pulmonary Vein Isolation of Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2010KOJI KUMAGAI M.D., Ph.D. Dormant Pulmonary Veins from the Carina Region.,Introduction: Elimination of transient pulmonary vein recurrences (dormant PVs) induced by an ATP injection and ablation at the PV carina region is an effective strategy for atrial fibrillation (AF) ablation. The relationship between dormant PVs and the PV carina region has not been evaluated. Methods: A total of 212 consecutive symptomatic AF patients underwent circumferential PV electrical isolation (CPVEI) with a double lasso technique. They were divided into 2 groups in a retrospective review; Group 1: those given an ATP injection during an intravenous isoproterenol infusion after the CPVEI (n = 106), and Group 2: those in which it was not given after the CPVEI (n = 106). Radiofrequency energy was applied at the earliest dormant PV activation site identified using a Lasso catheter on the CPVEI line and then PV carina region if it was ineffective. Results: After a successful PVEI, 54 patients (51%) in Group 1 had PV reconnections during an ATP injection. Acute PVEI sites were observed on the carina region within the CPVEI line in the right PVs (16%) and left PVs (10%). Dormant PVs were reisolated at the carina region in the right PVs (23%) and left PVs (26%). The distribution of the dormant PV sites, except for the RIPV, significantly differed from that of the acute PVEI sites (P < 0.05). Further, AF recurred significantly in the Group 2 patients as compared to those in Group 1 during 16 ± 6.1 months of follow-up (P < 0.05). Conclusion: PV carina region origins may partly be responsible for an acute PVEI and potential recurrences. (J Cardiovasc Electrophysiol, Vol. 21, pp. 494-500, May 2010) [source] Randomized Comparison of Bipolar versus Unipolar Plus Bipolar Recordings During Segmental Ostial Ablation of Pulmonary VeinsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2002HIROSHI TADA M.D. Unipolar vs Bipolar Electrograms.Introduction: Segmental ostial ablation to isolate pulmonary veins is guided by pulmonary vein potentials. The aim of this prospective randomized study was to compare the utility of unipolar plus bipolar electrograms versus only bipolar electrograms as a guide for segmental ablation to isolate the pulmonary veins in patients with atrial fibrillation. Methods and Results: Isolation of the left superior, right superior, and left inferior pulmonary veins was attempted in 44 patients (35 men and 9 women; mean age 54 ± 10 years) with paroxysmal atrial fibrillation. A decapolar Lasso catheter was positioned in the pulmonary veins, near the ostium, and a conventional ablation catheter was used for segmental ablation aimed at elimination of all pulmonary vein potentials. One hundred fourteen pulmonary veins were randomly assigned for ostial ablation guided by either bipolar or unipolar plus bipolar recordings. Electrical isolation was achieved in 51 (96%) of 53 pulmonary veins randomized to the bipolar approach, and 57 (93%) of 61 pulmonary veins randomized to the unipolar plus bipolar approach (P = 0.7). In the unipolar plus bipolar group, the total duration of radiofrequency energy needed to achieve isolation, 5.5 ± 2.8 minutes/vein, was significant shorter than in the bipolar group, 7.6 ± 4.1 minutes/vein (P < 0.01). Mean procedure and fluoroscopy durations per vein were 19% to 28% shorter in the unipolar plus bipolar group. Conclusion: Segmental ostial ablation to isolate the pulmonary veins can be achieved more efficiently and with less radiofrequency energy when guided by both unipolar and bipolar recordings than by bipolar recordings alone. [source] Extraction of the Inner Coil of a Pacemaker Lead Slid into the Pulmonary ArteryPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2007F.E.S.C., PIER GIORGIO GOLZIO M.D. A patient required lead extraction for chronic draining sinus, due to abandoned leads. Preoperatively, the chest film showed a filament in the right pulmonary artery: it was the inner coil of an old atrial lead that, while remaining anchored to the auricle, slid outside the outer coil. By right subclavian approach, the old ventricular lead and the outer coil of the atrial lead were removed. Then, by right jugular approach, the freely floating end of theinner atrial coil was grasped by a pig-tail catheter, drawn back into the superior vena cava, exteriorized by a Lasso catheter, and finally extracted. [source] Clinical Implications of Reconnection Between the Left Atrium and Isolated Pulmonary Veins Provoked by Adenosine Triphosphate after Extensive Encircling Pulmonary Vein IsolationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2007HITOSHI HACHIYA M.D. Introduction: Dormant pulmonary vein (PV) conduction can be provoked by adenosine triphosphate (ATP) after extensive encircling pulmonary vein isolation (EEPVI). However, the clinical implication of reconnection between the left atrium (LA) and isolated PVs provoked by ATP (ATP-reconnection) remains unknown. Methods and Results: We studied the clinical consequences of ATP-reconnection during intravenous isoproterenol infusion (ISP-infusion). EEPVI severs conduction between the LA and ipsilateral PVs at their junction. Radiofrequency energy is applied at a distance from the PV ostia guided by double Lasso catheters placed within the ipsilateral superior and inferior PVs. This study comprised 82 patients (67 men, 56 ± 9 years old) with atrial fibrillation (AF) who underwent injection of ATP during ISP infusion after successful EEPVI (ATP(+) group). We compared clinical characteristics of 170 patients who underwent earlier EEPVI prior to our use of ATP injection after successful EEPVI (ATP(N/D) group) with those of ATP(+) group patients who underwent one session of EEPVI. ATP-reconnection occurred in 34 (41%) of 82 ATP(+) group patients. Additional radiofrequency applications were performed to eliminate ATP-reconnection in all ipsilateral PVs. Continuous ATP-reconnection of more than 20 seconds duration occurred in six (7.3%) of 82 patients. A total of 102 (60%) of 170 patients in the ATP(N/D) group had no recurrence of AF, whereas 60 (73%) of 82 ATP(+) group patients who underwent only one EEPVI session have had no recurrence of AF in a 6.1 ± 3.3-month follow-up period (P = 0.04). Conclusion: Radiofrequency application for provoked ATP-reconnection may reduce clinical AF recurrence. [source] | ||||||||||