Hybrid epicardial and endocardial ablation of persistent or permanent atrial fibrillation: A new approach for difficult cases

Hui Nam Pak, Chun Hwang, Hong Euy Lim, Jin Seok Kim, Young Hoon Kim

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Epicardial AF Ablation. Background: Although percutaneous epicardial catheter ablation (PECA) has been used for the management of epicardial ventricular tachycardia, the use of PECA for atrial fibrillation (AF) has not yet been reported. Objective: To evaluate the efficacy and feasibility of a hybrid PECA and endocardial ablation for AF. Methods: We performed PECA for AF in five patients (48.6 ± 8.1 years old, all male, four redo ablation procedures of persistent AF with a risk of pulmonary vein (PV) stenosis, one de novo ablation of permanent [AF]) after an endocardial AF ablation guided by PV potentials and 3D mapping (NavX). Utilizing an open irrigation tip catheter, a left atrial (LA) linear ablation from the roof to the perimitral isthmus or localized ablation at the junction between the LA appendage and left-sided PVs or ligament of Marshall (LOM) was performed. Results: PECA of AF was successful in all patients with an ablation time of <15 minutes. The left-sided PV potentials were eliminated by PECA in all patients. Bidirectional block of the perimitral line was achieved in two of two patients and a left inferior PV tachycardia with conduction block to the LA was observed during the ablation in the area of the LOM in one patient. A hemopericardium developed in one patient, but was controlled successfully. During 8.0 ± 6.3 months of follow-up, all patients have remained in sinus rhythm (four patients without antiarrhythmic drugs). Conclusion: A hybrid PECA of AF is feasible and effective in patients with redo-AF ablation procedures and at risk for left-sided PV stenosis or who are resistant to endocardial linear ablation.

Original languageEnglish
Pages (from-to)917-923
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume18
Issue number9
DOIs
Publication statusPublished - 2007 Sep 1

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Atrial Fibrillation
Catheter Ablation
Pulmonary Veins
Ligaments
Atrial Appendage
Pericardial Effusion
Anti-Arrhythmia Agents
Ventricular Tachycardia
Tachycardia
Catheters

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

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title = "Hybrid epicardial and endocardial ablation of persistent or permanent atrial fibrillation: A new approach for difficult cases",
abstract = "Epicardial AF Ablation. Background: Although percutaneous epicardial catheter ablation (PECA) has been used for the management of epicardial ventricular tachycardia, the use of PECA for atrial fibrillation (AF) has not yet been reported. Objective: To evaluate the efficacy and feasibility of a hybrid PECA and endocardial ablation for AF. Methods: We performed PECA for AF in five patients (48.6 ± 8.1 years old, all male, four redo ablation procedures of persistent AF with a risk of pulmonary vein (PV) stenosis, one de novo ablation of permanent [AF]) after an endocardial AF ablation guided by PV potentials and 3D mapping (NavX). Utilizing an open irrigation tip catheter, a left atrial (LA) linear ablation from the roof to the perimitral isthmus or localized ablation at the junction between the LA appendage and left-sided PVs or ligament of Marshall (LOM) was performed. Results: PECA of AF was successful in all patients with an ablation time of <15 minutes. The left-sided PV potentials were eliminated by PECA in all patients. Bidirectional block of the perimitral line was achieved in two of two patients and a left inferior PV tachycardia with conduction block to the LA was observed during the ablation in the area of the LOM in one patient. A hemopericardium developed in one patient, but was controlled successfully. During 8.0 ± 6.3 months of follow-up, all patients have remained in sinus rhythm (four patients without antiarrhythmic drugs). Conclusion: A hybrid PECA of AF is feasible and effective in patients with redo-AF ablation procedures and at risk for left-sided PV stenosis or who are resistant to endocardial linear ablation.",
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Hybrid epicardial and endocardial ablation of persistent or permanent atrial fibrillation : A new approach for difficult cases. / Pak, Hui Nam; Hwang, Chun; Lim, Hong Euy; Kim, Jin Seok; Kim, Young Hoon.

In: Journal of Cardiovascular Electrophysiology, Vol. 18, No. 9, 01.09.2007, p. 917-923.

Research output: Contribution to journalArticle

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AU - Pak, Hui Nam

AU - Hwang, Chun

AU - Lim, Hong Euy

AU - Kim, Jin Seok

AU - Kim, Young Hoon

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N2 - Epicardial AF Ablation. Background: Although percutaneous epicardial catheter ablation (PECA) has been used for the management of epicardial ventricular tachycardia, the use of PECA for atrial fibrillation (AF) has not yet been reported. Objective: To evaluate the efficacy and feasibility of a hybrid PECA and endocardial ablation for AF. Methods: We performed PECA for AF in five patients (48.6 ± 8.1 years old, all male, four redo ablation procedures of persistent AF with a risk of pulmonary vein (PV) stenosis, one de novo ablation of permanent [AF]) after an endocardial AF ablation guided by PV potentials and 3D mapping (NavX). Utilizing an open irrigation tip catheter, a left atrial (LA) linear ablation from the roof to the perimitral isthmus or localized ablation at the junction between the LA appendage and left-sided PVs or ligament of Marshall (LOM) was performed. Results: PECA of AF was successful in all patients with an ablation time of <15 minutes. The left-sided PV potentials were eliminated by PECA in all patients. Bidirectional block of the perimitral line was achieved in two of two patients and a left inferior PV tachycardia with conduction block to the LA was observed during the ablation in the area of the LOM in one patient. A hemopericardium developed in one patient, but was controlled successfully. During 8.0 ± 6.3 months of follow-up, all patients have remained in sinus rhythm (four patients without antiarrhythmic drugs). Conclusion: A hybrid PECA of AF is feasible and effective in patients with redo-AF ablation procedures and at risk for left-sided PV stenosis or who are resistant to endocardial linear ablation.

AB - Epicardial AF Ablation. Background: Although percutaneous epicardial catheter ablation (PECA) has been used for the management of epicardial ventricular tachycardia, the use of PECA for atrial fibrillation (AF) has not yet been reported. Objective: To evaluate the efficacy and feasibility of a hybrid PECA and endocardial ablation for AF. Methods: We performed PECA for AF in five patients (48.6 ± 8.1 years old, all male, four redo ablation procedures of persistent AF with a risk of pulmonary vein (PV) stenosis, one de novo ablation of permanent [AF]) after an endocardial AF ablation guided by PV potentials and 3D mapping (NavX). Utilizing an open irrigation tip catheter, a left atrial (LA) linear ablation from the roof to the perimitral isthmus or localized ablation at the junction between the LA appendage and left-sided PVs or ligament of Marshall (LOM) was performed. Results: PECA of AF was successful in all patients with an ablation time of <15 minutes. The left-sided PV potentials were eliminated by PECA in all patients. Bidirectional block of the perimitral line was achieved in two of two patients and a left inferior PV tachycardia with conduction block to the LA was observed during the ablation in the area of the LOM in one patient. A hemopericardium developed in one patient, but was controlled successfully. During 8.0 ± 6.3 months of follow-up, all patients have remained in sinus rhythm (four patients without antiarrhythmic drugs). Conclusion: A hybrid PECA of AF is feasible and effective in patients with redo-AF ablation procedures and at risk for left-sided PV stenosis or who are resistant to endocardial linear ablation.

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