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Catheter ablation of atrial fibrillation originating from extrapulmonary vein areas: Taipei approach

  • Satoshi Higa
    Affiliations
    Second Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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  • Ching-Tai Tai
    Affiliations
    Division of Cardiology, Department of Medicine, and Cardiovascular Research Center, National Yang-Ming University School of Medicine, and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.
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  • Shih-Ann Chen
    Correspondence
    Address reprint requests and correspondence: Dr. Shih-Ann Chen, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 201 Section 2, Shih-Pai Road, Taipei, Taiwan.
    Affiliations
    Division of Cardiology, Department of Medicine, and Cardiovascular Research Center, National Yang-Ming University School of Medicine, and Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.
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Published:September 12, 2006DOI:https://doi.org/10.1016/j.hrthm.2006.09.006
      The pulmonary veins (PVs) are a dominant source of ectopic activity initiating atrial fibrillation (AF).
      • Haissaguerre M.
      • Jais P.
      • Shah D.C.
      • Takahashi A.
      • Hocini M.
      • Quiniou G.
      • Garrigue S.
      • Le Mouroux A.
      • Le Metayer P.
      • Clementy J.
      Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.
      • Chen S.A.
      • Hsieh M.H.
      • Tai C.T.
      • Tsai C.F.
      • Prakash V.S.
      • Yu W.C.
      • Hsu T.L.
      • Ding Y.A.
      • Chang M.S.
      Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation.
      We and others have demonstrated that extra-PV ectopic activity could initiate AF, and elimination of ectopic activity can cure this specific group of patients with AF.
      • Tsai C.F.
      • Tai C.T.
      • Hsieh M.H.
      • Lin W.S.
      • Yu W.C.
      • Ueng K.C.
      • Ding Y.A.
      • Chang M.S.
      • Chen S.A.
      Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava: electrophysiological characteristics and results of radiofrequency ablation.
      • Lin W.S.
      • Tai C.T.
      • Hsieh M.H.
      • Tsai C.F.
      • Lin Y.K.
      • Tsao H.M.
      • Huang J.L.
      • Yu W.C.
      • Yang S.P.
      • Ding Y.A.
      • Chang M.S.
      • Chen S.A.
      Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy.
      • Higa S.
      • Tai C.T.
      • Chen S.A.
      Catheter ablation of paroxysmal atrial fibrillation originating from the non-pulmonary vein areas.
      • Chen S.A.
      • Tai C.T.
      Catheter ablation of atrial fibrillation originating from the non-pulmonary vein foci.
      The Bordeaux group demonstrated that extensive ablation of extra-PV areas after isolation of all four PVs can convert chronic AF to focal or macroreentrant atrial tachycardias, and further elimination of these atrial tachycardias could maintain sinus rhythm in approximately 90% of patients with chronic AF.
      • Haissaguerre M.
      • Hocini M.
      • Sanders P.
      • Takahashi Y.
      • Rotter M.
      • Sacher F.
      • Rostock T.
      • Hsu L.F.
      • Jonsson A.
      • O’Neill M.D.
      • Bordachar P.
      • Reuter S.
      • Roudaut R.
      • Clementy J.
      • Jais P.
      Localized sources maintaining atrial fibrillation organized by prior ablation.
      Furthermore, we also showed initiation of AF without any initiating PV ectopy, presumably due to reentry.
      • Lin Y.J.
      • Tai C.T.
      • Kao T.
      • Tso H.W.
      • Huang J.L.
      • Higa S.
      • Yuniadi Y.
      • Huang B.H.
      • Liu T.Y.
      • Lee P.C.
      • Hsieh M.H.
      • Chen S.A.
      Electrophysiological characteristics and catheter ablation in patients with paroxysmal right atrial fibrillation.
      Therefore, we must consider the important role of both ectopy and reentry from extra-PV areas in the initiation and maintenance of AF, not only in patients with paroxysmal AF but also those with chronic AF.
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