A Trial of the Electrogram Guided Catheter Ablation for Long-Lasting Recurrent Atrial Fibrillation Case: Case Report
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概要
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<B>Introduction:</B> The endpoint of electrical pulmonary vein (PV) isolation is the agreed goal of procedures targeting the PV-left atrial junction in paroxysmal atrial fibrillation (AF). On the other hand, the targets and endpoints of ablation for chronic (persistent and long-lasting) AF are ill-defined. <B>Results:</B> A 69-year-old male with long-lasting AF was referred for catheter ablation. We performed complex fractionated atrial electrogram (CFAE) guided catheter ablation for AF. AF spontaneously terminated after CFAE guided catheter ablation. After which, frequent premature atrial contractions (PACs) occurred and were mapped and successfully ablated. Our endpoint of CFAE guided catheter ablation in patients with chronic AF used to AF termination. Recently, we use isoproterenol (ISP) to induce AF after AF termination even if AF is non-paroxysmal. Isthmus dependent atrial flutter (AFL) was induced by ISP in this case. AFL was terminated by TV-IVC linear ablation. Repeat induction with rapid atrial pacing and high dose ISP failed to re-induce any atrial tachyarrhythmias. This patient remains in sinus rhythm without any atrial arrhythmia recurrent >7 months after this procedure. <B>Conclusions:</B> Repeat AF induction after AF termination during CFAE guided ablation may be useful to unmask remaining atrial tachyarrhythmia substrate which could be successfully ablated and could help minimizing a chance for a redo procedure in patients with long-lasting AF.
著者
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Tei Chuwa
Department Of Cardiology Kagoshima University
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Ninomiya Yuichi
Department Of Agricultural Chemistry Faculty Of Agriculture Tokyo University Of Agriculture
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Nademanee Koonlawee
Pacific Rim Electro-physiology Research Institute
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Tei Chuwa
Department of Cardiovascular, Respiratory and Metabolic Medicine, Kagoshima University
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Ninomiya Yuichi
Department of Cardiovascular, Respiratory and Metabolic Medicine, Kagoshima University
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