MF Márquez, L Colín, ME Guevara-Valdivia, P Iturralde, R Castañeda, R Villavicencio, JA González Hermosillo, MA Martínez-Ríos, R Frank, M Cárdenas

Language: Spanish
References: 7
Page: 124-128
PDF size: 80.16 Kb.

ABSTRACT

Several studies have shown the role of focal triggers in the pulmonary veins initiating episodes of atrial fibrillation. Radiofrequency catheter ablation of this foci is a curative therapy for paroxysmal atrial fibrillation. We report a case of idiopathic paroxysmal atrial fibrillation triggered by abnormal electrical activity in a single pulmonary vein. Mapping was performed during sinus rhythm with a 4F decapolar catheter (Spiral Supreme, Daig, St. Jude Medical) positioned near the ostium by a transseptal approach. Pulmonary vein potentials were only identified in the left superior pulmonary vein. Segmental ostial ablation (30 W) performed during left atrial pacing resulted in complete cesation of conduction in the pulmonary vein. There were no complications. The clinical response (suppression of the paroxysms of atrial fibrillation in a 9-month follow-up) observed in this patient imply that atrial fibrillation was triggered by this pulmonary vein. This case report illustrates several aspects of catheter-based ablation of pulmonary vein foci for the treatment of paroxysmal atrial fibrillation and demonstrates its efficacy.

REFERENCES

1. Mackenzie J: Diseases of the heart. 3a ed. 1914, p. 211-6. Tomado de: Willius FA, Keys TE: Classics of Cardiology. Vol. 2. Nueva York. Henry Schuman Inc., 1941, p. 769-800.

2. Schwartz SP: The effects of digitalis on premature auricular contractions associated with attacks of paroxysmal auricular fibrillation. The use of the drug in the treatment and prevention of certain forms of these arrhythmias. Am Heart J 1931; 6: 458-71.

3. Langeron L: Troubles électriques de la contraction auriculaire précédant la fibrillation de l’oreillete; existence d’un stade pré-fibrillatoire. Arch Mal Coeur Vaiss Sang 1932; 1: 34-9.

4. Haïssaguerre M, Jaïs P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Métayer P, Clémenty J: Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659-66.

5. Haïssaguerre M, Jaïs P, Shah DC, Lavergne T, Hocini M, Takahashi A, Barold SS, Clémenty J: Catheter ablation of paroxysmal atrial fibrillation: results in 234 patients. En: Huang SKS, Wilber DJ (eds). Radiofrequency catheter ablation of cardiac arrhythmias: Basic concepts and clinical applications. 2a ed. Armonk, NY: Futura Publishing Co, Inc. 2000; p. 305-25.

6. Iturralde P, Medeiros A, Guevara M, Kershenovich S, Varela S, Colín L: Fibrilación auricular focal tratada mediante radiofrecuencia. Arch Inst Cardiol Méx 2000; 70: 167-72.

7. Robbins IM, Colvin EV, Doyle TP, Kemp E, Loyd JE, McMahon WS, Kay GN: Pulmonary vein stenosis after catheter ablation of atrial fibrillation. Circulation 1998; 98: 1769-75.