Pulmonary isolation: an excelent alternative to address atrial fibrillation
Aislamiento pulmonar: excelente alternativa ante la fibrilación auricular
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Olaya Sánchez, A., & Hennessey Sánchez, J. M. (2012). Pulmonary isolation: an excelent alternative to address atrial fibrillation. Journal of Medicine and Surgery Repertoire, 21(1), 25–34. https://doi.org/10.31260/RepertMedCir.v21.n1.2012.791
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Research Article
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Abstract
Atrial fibrillation (AF) is a fast and irregular heart arrhythmia that starts in the atria. The rate may range from 400 to 700 beats per minute. It is the most common continuous arrhythmia in humans. Its prevalence is around 0.5% according to the study population and reaches up to 8% in elders. AF-related morbidity, mortality and economic burden are significant and will increase as elderly population increases. Until not long ago, therapy was based on pharmacological AV node blockage using antiarrhythmic and anticoagulant agents. Although electrical cardioversion is associated with a high immediate success rate, the majority of patients may have relapses with only the remaining 23% maintaining a normal sinus rhythm a year after the procedure. Recently there has been great interest in pulmonary vein isolation. This technique consists on inserting a multielectrode catheter and mapping the os of the pulmonary veins to identify the venoatrial attachment occupied by muscle bands extending from the Ieft atrium to the pulmonary veins. Discon nection of these muscle fibers is enabled by applying radiofrequency energy to these areas. A review of the appropriate technique was conducted when handling one patient at the Hospital Cardiovascular del Niño de Cundinamarca.
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References
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2. Kannel WB, Abbott RD, Savage DO, McNamara PM. Coronary heart disease and atrial fibrillation: the Framingham Study. Am Heart J. 1983;106:389-96.
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8. Fuster V. Ryden LE, Asinger RW, Cannom OS, Crijns HJ, Frye RL, et al. ACC/ AHA/ESC guidelines far the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee far Practice Guidelines and Policy Conferences (Committee to develop guideli nes far the management of patients with atrial fibrillation) developed in collabo ration with the North American Society of Pacing and Electrophysiology. Eur Heart J. 2001;22:1852-923.
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12. Chen YJ, Chen SA. Elecrrophysiology of pulmonary veins. J Cardiovasc Electro physiol. 2006;17:220-4.
13. Wellens HJ. Pulmonary vein ablation in atrial fibrillation: hype or hope? Circula tion. 2000;102:2562-4.
14. Chen SA, Hsieh MH, Tai CT, Tsai CF, Prakash VS, Yu WC et al. lnitiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: electro physiological characteristics, pharmacological responses, and effects of radiofre quency ablation. Circulation. 1999;100:1879-86.
15. Silva R, Mont Ll, Berruezo A, Fosch X, Wayar L, Alvarenga N, et al. Ablación por radiofrecuencia para el tratamiento de la fibrilación auricular focal a través de cartografía circunferencial y aislamiento segmentario de las venas pulmonares. Rev Esp Cardiol. 2003;56(4):361-7.
16. Stabile G, Turco P, La Rocca V, Nocerino P, StabiJe E, De Simone A. Is pul monary vein isolation necessary far curing atrial fibrillation? Circulation. 2003;108:657-60.
17. Hamabe S, Okuyama Y, Miyauchi Y, Zhou S, Pak HN, Karagueuzian HS, et al. Correlation between anatomy and electricaJ activation in canine pulmonary veins. Circulation. 2003;107:1550-5.
18. Ouyang F, Bansch D, Ernst S, Schaumann A, Hacbiya H, Chen M. Comple te isolation of left atrium surrounding the pulmonary veins: new insights from the doub]e-Lasso technique in paroxysmal atrial fibrillation. Circulation. 2004;110:2090-6.
19. Chung MK, Martín DO, Sprecher O, Wazni O, Kanderian A, Carnes CA, et al. C-reactive protein elevation in patients with atrial arrhythmias: Inflammatory mechanisms and persistence of atrial fibrillation. Circulation. 2001;104:2886-91.
20. Velarde JL, Martellotto R, Scanavaca M, Arévalo A, Calque R, Jimenez M, et al. Ablación de las venas pulmonares en la fibrilación auricular. Experiencia inicial. Rev Esp Cardiol. 2002;55(5):541-5.
21. Haissaguerre M, Shah DC, Jais P, Hocini M, Yamane T, Deisenhofer l. Map ping - guided ablation of pulmonary veins to cure atrial fibrillation. 2000 Nov 2;86(9A):9K-l 9K 2000 Nov 2; 86(9A):9K- l 9K.
22. Pappone C, Rosanio S, Oreto G, Tocci M, Gugliotta F, Vicedomini G, et al. Cir cumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach far curing atrial fibrillation. Circulation. 2000;102:2619-28.
2. Kannel WB, Abbott RD, Savage DO, McNamara PM. Coronary heart disease and atrial fibrillation: the Framingham Study. Am Heart J. 1983;106:389-96.
3. Kato R, Lickfett L, Meininger G, Dickfeld T, Wu R, Juang G, et al. Pulmo nary vein anatomy in patients undergoing catheter ablation of atrial fibrillation: lessons learned by use of magnetic resonance imaging. Circulation. 2003; I 07 2004-10.
4. Oral H, Pappone C, Chugh A, Good E, Bogun F, Pelosi F, et al. Circumfer ential Pulmonary - vein ablation far chronic arrial fibrillation. N Engl J Med. 2006;354:934-41.
5. Wyndharn CR. Atrial fibrillation: The most common arrhythmia. Texas Heart Institute Joumal. 2000;27:257-67.
6. Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originated in the pul monary veins. NEJM. 1998;339:659-66.
7. Márquez MF, Colú1 L, Guevara-Valdivia ME, Itmralde P, Castañeda R, Yillavi cencio R, et al. Ablación segmentaría del ostium de la vena pulmonar superior izquierda para eliminar actividad eléctrica anormal generada de fibrilación arria] paroxística idiopática. Arch Cardiol Mex. 2003;73:124-8.
8. Fuster V. Ryden LE, Asinger RW, Cannom OS, Crijns HJ, Frye RL, et al. ACC/ AHA/ESC guidelines far the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee far Practice Guidelines and Policy Conferences (Committee to develop guideli nes far the management of patients with atrial fibrillation) developed in collabo ration with the North American Society of Pacing and Electrophysiology. Eur Heart J. 2001;22:1852-923.
9. Vargas J. Tratado de Cardiología. Sociedad Mexicana de Cardiología. México. 2006;320-7.
10. Calkins H, Yang P, Miller JM, Olshansky 8, Carlson M, Saul JP, et al. Cathe ter ablation of accessory pathways, atrioventricular nada! reentrant tachycar dia, and the atrioventricular junction: final results of a prospective, multi center clinical tria!. The Atakr Multicenter Investigators Group. Circulation. 1999;99(2):262-70.
11. Wijffels MCEF. Kirchhof CJHJ, Doland R, Allessie MA. Atrial fibrillation be gets arria] fibrillation. A study in awake chronically instrumented gotas. Circula tion. 1995;92:1954-68.
12. Chen YJ, Chen SA. Elecrrophysiology of pulmonary veins. J Cardiovasc Electro physiol. 2006;17:220-4.
13. Wellens HJ. Pulmonary vein ablation in atrial fibrillation: hype or hope? Circula tion. 2000;102:2562-4.
14. Chen SA, Hsieh MH, Tai CT, Tsai CF, Prakash VS, Yu WC et al. lnitiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: electro physiological characteristics, pharmacological responses, and effects of radiofre quency ablation. Circulation. 1999;100:1879-86.
15. Silva R, Mont Ll, Berruezo A, Fosch X, Wayar L, Alvarenga N, et al. Ablación por radiofrecuencia para el tratamiento de la fibrilación auricular focal a través de cartografía circunferencial y aislamiento segmentario de las venas pulmonares. Rev Esp Cardiol. 2003;56(4):361-7.
16. Stabile G, Turco P, La Rocca V, Nocerino P, StabiJe E, De Simone A. Is pul monary vein isolation necessary far curing atrial fibrillation? Circulation. 2003;108:657-60.
17. Hamabe S, Okuyama Y, Miyauchi Y, Zhou S, Pak HN, Karagueuzian HS, et al. Correlation between anatomy and electricaJ activation in canine pulmonary veins. Circulation. 2003;107:1550-5.
18. Ouyang F, Bansch D, Ernst S, Schaumann A, Hacbiya H, Chen M. Comple te isolation of left atrium surrounding the pulmonary veins: new insights from the doub]e-Lasso technique in paroxysmal atrial fibrillation. Circulation. 2004;110:2090-6.
19. Chung MK, Martín DO, Sprecher O, Wazni O, Kanderian A, Carnes CA, et al. C-reactive protein elevation in patients with atrial arrhythmias: Inflammatory mechanisms and persistence of atrial fibrillation. Circulation. 2001;104:2886-91.
20. Velarde JL, Martellotto R, Scanavaca M, Arévalo A, Calque R, Jimenez M, et al. Ablación de las venas pulmonares en la fibrilación auricular. Experiencia inicial. Rev Esp Cardiol. 2002;55(5):541-5.
21. Haissaguerre M, Shah DC, Jais P, Hocini M, Yamane T, Deisenhofer l. Map ping - guided ablation of pulmonary veins to cure atrial fibrillation. 2000 Nov 2;86(9A):9K-l 9K 2000 Nov 2; 86(9A):9K- l 9K.
22. Pappone C, Rosanio S, Oreto G, Tocci M, Gugliotta F, Vicedomini G, et al. Cir cumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach far curing atrial fibrillation. Circulation. 2000;102:2619-28.