Objective To investigate the safety and efficacy of circumferential pulmonary vein linear ablation guided by 3-D mapping system in patients with atrial fibrillation.Methods From April 2003 to March 2006,410 consecutive patients with atrial fibrillation underwent circumferential pulmonary vein linear ablation guided by 3-D mapping system(CARTO system or EnSite NavX TM system).Success was defined as symptomatic atrial tachyarrhythmia free after 3 months washout period.Results 96%of the 410 patients attained the ablation endpoint.After a mean of (12.4?6.8)months' follow-up,clinical success achieved in 77.3% of the patients with paroxysmal atrial fibrillation and 69.4% of the patients with persistent/permanent atrial fibrillation after first-time ablation procedure.The successs rate of the persistent/permanent atrial fibrillation was significantly lower than that of paroxysmal atrial fibrillation.Forty-one of the 103 patients with recurrent atrial fibrillation underwent ablation again.Thirty-one of the 41 patients(75.6%)were atrial tachyarrhythmia free during the follow-up.Severe complications included 4 cases of pericardial tamponade(0.97%)and 3 cases of stroke(0.73%).Pericardial tamponades were relieved by pericardiocentesis.The patients with stroke recovered well without any lingering effects.There was no death case.Conclusion Circumferential pulmonary vein linear ablation guided by 3-D mapping system is an effective therapy for atrial fibrillation patients with an acceptable safety.

BACKGROUND:Circumferential pulmonary vein antrum ablations guided by CARTO system or integration of a computed tomographic or magnetic resonance imaging scan (CARTO-Merge) are two main locating methods.Theoretically,CARTO-Merge provides a detailed appreciation of the pulmonary vein anatomy,however,whether it can improve the safety and success of catheter ablation of atrial fibrillation remains uncertainly.OBJECTIVE:To explore the effect of CT image integration into three-dimensional (3D) electroanatomical mapping system on clinical outcomes of catheter ablation of atrial fibrillation.DESIGN,TIME AND SETTING:The randomized contrast observation was performed at Department of Cardiology of Beijing Anzhen Hospital from October 2005 to May 2007.PARTICIPANTS:A total of 93 patients with drugs refractory,paroxysmal atrial fibrillation who underwent circumferential pulmonary vein antrum ablation.METHODS:All patients underwent circumferential pulmonary vein antrum ablation using irdgated radiofreguency ablation with the endpoint of electrical isolation.Ablation was guided by 3D mapping alone in 50 patients (CARTO group) or by CT image integration in 43 patients (CARTO-Merge group).MAIN OUTCOME MEASURES:Procedure-related parameters,such as procedure duration,fluoroscopy duration,cumulative success rate and complication,were compared between the two groups.RESULTS:Pulmonary veins were isolated in all patients.After (12.6±2.9) months follow-up,73 (78.5%) patients did not have recurrence of atrial fibrillation at 3 month after the procedure.The fluoroscopy time in CARTO group was significant longer than that in CARTO-Merge group (P<0.05).The mean procedure duration,radiofrequency ablation duration,procedure-related complication and cumulative success rate were comparable between the 2 groups.CONCLUSION:Circumferential pulmonary vein antrum ablation guided by 3D mapping alone or by CT integration had similar safety and success rate in paroxysmal atrial fibrillation patients.But CT integration,which facilitated to a detailed representation of the anatomy of left atrium,is associated with reduced fluoroscopy duration.

Objective To evaluate the clinical efficacy and safety of catheter ablation for atrial fibrillation in elderly patients.Methods From September 2008 to October 2011,a total of 420 consecutive patients undergoing catheter ablation of atrial fibrillation (AF) were selected.The patients were divided into 3 age groups:30 59 yr group (n=279),60-74 yr group (n=100),and 75-87 yr group (n =41).The effect of operation and complications during operative and postoperative periods were evaluated.Patients were followed up for at least 6 months,and the rate of atrial fibrillation reocurrence and life quality were recorded.Results Among 480 catheter ablation procedures,in 7 (1.5％) patients occurred main complications,while in 5 (1.0％) patients appeared other complications.The incidence of main complications in 3 groups were 1.1％ (3 patients),2.0％ (2 patients) and 4.9％ (2 patients) respectively,other complication rates in 3 groups were 0.7％ (2 patients),1.0％ (1 patient) and 4.9％ (2 patients) respectively and there were no differences between groups (all P＞0.05).During follow-up,the cases without AF relapse were 68.5％ (191 patients),66.0％ (66 patients) and 57.1％ (23 patients) respectively,and the patients with AF paroxysm were 21.1％ (59 patients),21.0％ (21 patients),29.3％ (12 patients) respectively,and there was no significant difference between groups (all P＞0.05).And no difference was found in improvement degree of life quality among three groups (P＞0.05).Conclusions Catheter ablation is safe and effective in elderly patients.For patients over 75 years with many types of cardiovascular diseases,catheter ablation is effective to control the relapse of AF,can significantly improve the quality of life,and has no increased risk of complications.

Objective To investigate ablation characteristics of PVC/VT originating from left ventricle anterior papillary muscles.Methods This study included 10 patients of PVC/VT originating from left ventricle anterior papillary muscles from January 2015 to June 2016 in Beijing Anzhen Hospital.Electrophysiological mapping and radiofrequency ablation were completed using three-dimensional anatomical mapping system combined with three-dimensional intracardiac ultrasound technology.ECG and abaltion target diagram characteristics as well as the special anatomy were explored.Results All the 10 patients were successfully ablated and followed up for 12 months.One patient had recurrence within 12 months and no complications were recorded.The target sites localized at the tip (n =1),middle portion(n =4)or the base (n =5) of the LV-APM.Among 7 patients,the target sites were located at the anterior septal papillary muscle and in 3 patients were located in the free papillary muscle.9 patients were successfully ablated via anterograde trans-septal catheterization after the failure of retrograde approach.Premature QRS wave time were 152.80 ± 11.72 ms and 6 patients presented sharp potential at the targets during PVC/VT.Conclusions PVC/VT originating from left ventricle anterior papillary muscles have similar ECG and diagram characteristics that is different from which originating from left anterior fascicle.It is recommended to get the target via transseptalpuncure approach.Ablation target could be clearly positioned by three-dimensional intracardiac ultrasound technology.

Objective The recurrence of perimitral atrial tachycardia is common after initial ablation of persistent atrial fibrillation (AF). The aim of the study is to explore a preferable ablation approach for perimitral atrial tachycardia in the redo ablation of persistent AF. Methods Seventy-four patients with perimitral atrial tachycardia after initial ablation for persistent AF were included in our study. Patients were distinguished into either the group of having ablation during tachycardia (Group A) or the group having ablation after cardioversion to sinus rhythm (Group B) according to the different ablation strategies. The procedural endpoints were pulmonary vein isolation and bidirectional conduction block of all the ablated lines. The primary endpoint of the study was freedom from atrial tachyarrhythmia recurrence during the follow-up period. Results There were statistical differences in baseline clinical data between the 2 groups. During the redo procedure, conduction recovery rate across the mitral isthmus (MI),cavotricuspid isthmus and left atial roofline were 100％, 40.5％ and 48.6％ respectively. The procedural time, fluoroscopy time, mapping time were longer in the patients of group A. During a mean follow-up of (16.9±6.3) months, 31 (72.1％) patients in group A and 21(67.7％) patients in group B maintained in sinus rhythm in the absence of antiarrhythmic durgs (P =0.771) . Conclusion In patients with perimitral atrial tachycardia after initial ablation for persistent AF,ablation in sinus rhythm is a more simplified method and as effective as ablation during tachycardia.

Objective To observe the management and outcome of the cardiac tamponade patients during the ablation procedure using two different anticoagulation strategies. Methods All the patients developed tamponade during the ablation procedure were enrolled from January 2007 to December 2013 in our center. In group 1, warfarin was discontinued 3 to 5 days before the procedure and low molecular weight heparin (LMWH) was administered subcutaneously until ablation procedure day. In group 2, warfarin was not discontinued and the international normalized ratio INR was to maintained between 2 and 3. Results There were 27 patients (0.6%) developed cardiac tamponade out of a total 4487 patients received ablation in our center. The baseline clinical characteristics including age, left atrium, the heparin dose and ACT during the procedure had no signiifcant difference between the groups, except that the INR was higher in the group 2 (0.9±0.1 vs. 2.3±0.5, P<0.001). There was no signiifcant difference in the amount of pericardiac drainage between the two groups (365±222 ml vs. 506±300 ml, P=0.137). Two patients in group 1 patient (11.1%) and 1 in group 2 (11.1%) needed emergency surgical repair (P>0.999). The median hospital day was similar in the 2 groups [(9.6±3.3) d vs. (12.1±4.5) d, P=0.167]. There were no other serious complications and no hospital death. Conclusions Non-discontinuation of warfarin during peri-procedural catheter ablation of AF is not signiifcantly different to bridging with LMWH in the management and outcome of acute cardiac tamponade.

Objective Identify the mechanism of induced atrial arrhythmias after pulmonary vein isolation (PVI) in patients with paroxysmal atrial ifbrillation(PAF), and investigate its long-term prognosis. Methods All patients with PAF undergoing PVI and induction test afterwards between Feburary 2010 and October 2010 were included. The induction protocol was rapid pacing initiated at cycle length of 250 ms with progressive shortening in a decrement of 10 ms down to 180 ms or refractoriness. Isoproterenol of 2-4μg/min was administrated as well. Inducibility was deifned as induction of atrial arrhythmia lasting >1 min. The mechanism of induced tachycardia was identiifed by activation mapping and entrainment mapping under the guidance of CARTO system. All patients were followed up by 36 months. Results Forty-nine atrial tachycardia were induced in 39 (19.7%) patients, including 35 organized atrial tachycardia (OAT) and 14 atrial ifbrillation (AF). The LA diameter was signiifcantly larger in inducible group than non-inducible group (39.5±6.6 mm vs. 36.7±5.2 mm, P=0.004). Macroreentry was the most common mechanism in induced OATs (28, 80.0%), and mitral isthmus was the most common critical site (20, 40.8%), followed by cavo-tricuspid isthmus (12, 24.5%), PV (6, 12.2%), LA septum (4, 8.2%), superior vena cava (3, 6.1%) and LA roof (1, 2.0%). Conclusions The most common mechanism of induced tachycardia by IV isoproterenol and rapid pacing is MI and CTI dependent after PVI in PAF patients, which can be succssefully eliminated by liner ablation, not increasing long-term recurrence rate.

Objective To identify the electrophysiological charateristics and cause of ridge gap related reentry after MI ablation in atrial ifbrillation patients. Methods Activation and entrainment mapping was performed in 82 redo cases for OAT recurrence in whom MI was ablated during the index produre. Once ridge gap related reentry was conifrmed, detailed mapping was performed in MI and ridge region. In addition, in 36 cases undergoing MI ablation and fulfilling criterion for bidirectional block, differential pacing was repeated at the ridge to identify a ridge gap. Results Out of 82 redo cases for OAT recurrence in whom MI was ablated during the index produre, 7 (8.5%) was found to be ridge gap related reentry. TCL was (247.9±19.2) ms, and the left atrial endocardial activation time was (145.4±17.7) ms, accounting for (58.5±3.2)%of TCL. However, wide double potential was recorded along the previous ablated MI line where PPI was (34.3±6.6) ms longer than TCL, while PPI was signiifcantly shorter at the ridge[PPI-TCL (11.4±3.9) ms, P<0.001]. Tachycardia was terminated at the ridge in 6 cases and at the corresponding site in coronary sinus in 1 case. No recurrence was found during follow-up for (11.1±4.5) months. In addition, in 36 patients undergoing MI ablation in whom criterion of bi-directional block was fuliflled, conduction gap located at the ridge was found in 5 (13.9%) cases. Conclusions MI ridge gap related reentry is a distinctive OAT, in which the ridge was used as the critical isthmus, whereas the previous ablated MI line is not part of the reentry. MI pseudo-block due to the ridge gap may lead to this type of recurrent tachycardia.

Objectives To address whether menopause affects outcome of catheter ablation (CA) for atrial fibrillation (AF) by comparing the safety and long-term outcome of a single-procedure in pre-and post-menopausal women. Methods A total of 743 female patients who underwent a single CA procedure of drug-refractory AF were retrospectively analyzed. The differences in clinical presentation and outcomes of CA for AF between the pre-menopausal women (PreM group, 94 patients, 12.7%) and the post-menopausal women (PostM group, 649 patients, 87.3%) were assessed. Results The patients in the PreM group were younger (P<0.001) and less likely to have hypertension (P<0.001) and diabetes (P=0.005) than those in the PostM group. The two groups were similar with regards to the proportion of concomitant mitral valve regurgitation coronary artery disease, left atrium dimensions, and left ventricular ejection fraction. The overall rate of complica-tions related to AF ablation was similar in both groups (P=0.385). After 43 (16-108) months of follow-up, the success rate of ablation was 54.3%in the PreM group and 54.2%in the PostM group (P=0.842). The overall freedom from atrial tachyarrhythmia recurrence was simi-lar in both groups. Menopause was not found to be an independent predictive factor of the recurrence of atrial tachyarrhythmia. Conclusions The long-term outcomes of single-procedure CA for AF are similar in pre-and post-menopausal women. Results indicated that CA of AF appears to be as safe and effective in pre-menopausal women as in post-menopausal women.

Objective: The aim of the study was to evaluate the changes and outcome of kidney function after catheter ablation in patients with persistent atrial fibrillation (PAF). Methods: A total of 146 patients with PAF underwent primary atrial fibrillation (AF) ablation were enrolled from January 2013 to December 2014 and followed up. The subjects were divided into the AF recurrence and AF non recurrence groups. The estimated glomerular filtration rate (eGFR) was calculated and serum creatinine levels were detected before ablation and during follow-up. Renal failure was defined as ≥ 25% decline in eGFR. Kaplan-Meier survival curves was applied for the incidence of renal failure. Cox proportional hazards models were conducted to assess the relationship between recurrence of AF and renal failure. Results: After (16.3±11.8) months of follow-up, the eGFR in patients with no recurrence of AF was higher than that in patients with recurrence. eGFR and ΔeGFR in patients with no AF recurrence differed significantly from those in patients with recurrence [(114.15±18.24) ml·min^-1·1.73m^-2 vs. (98.64±24.09) ml·min^-1·1.73m^-2, and (7.42±6.36) ml·min^-1·1.73m^-2 vs. (-11.40±10.19) ml·min^-1·1.73m^-2, all P<0.001]. The incidence of the renal failure was significantly lower (4.41% vs. 16.67%, P<0.05) and the survival prognosis was significantly better in patients with no recurrence than those in patients with recurrence (χ²=5.965, log-rank P=0.05). The multivariate Cox regression analysis revealed that age, baseline eGFR, recurrences of AF and diabetes were independent predictors of the renal failure, with the HR 1.152, 1.086, 13.442 and 6.076, respectively. Conclusions PAF patients with no recurrence after ablation had a better renal function than those with recurrence, and the recurrence of AF is associated with the deterioration of kidney function in patients with PAF.