Publications
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Schneider C, Ernst S, Malisius R, et al., 2007, Transesophageal echocardiography: A follow-up tool after catheter ablation of atrial fibrillation and interventional therapy of pulmonary vein stenosis and occlusion, Journal of Interventional Cardiac Electrophysiology, Vol: 18, Pages: 195-205, ISSN: 1383-875X
ERNST S, CHUN JKR, UJEYL A, et al., 2007, “Sequential” Mapping Mimicking “Simultaneous” Mapping Using Magnetic Navigation During Catheter Ablation of Supraventricular Tachycardia: Results of the Single DX Study, Journal of Cardiovascular Electrophysiology, Vol: 18, ISSN: 1045-3873
<jats:p> <jats:italic>Introduction:</jats:italic> The magnetic navigation system (MNS) allows remote‐controlled navigation of an ablation catheter from the control room. We tested the hypothesis, whether the MNS and a single additional diagnostic nonsteerable catheter would have the potential to identify the tachycardia substrate and allow subsequent ablation in patients with documented supraventricular tachycardia (SVT).</jats:p><jats:p> <jats:italic>Methods and Results:</jats:italic> A total of 41 patients (24 females, age 45 ± 16 years) underwent an invasive electrophysiologic (EP) study using the MNS. Together with a conventional diagnostic catheter in the right ventricle, the magnetic catheter (MC) was used to investigate the underlying EP substrate in a sequential fashion and subsequently to perform radiofrequency (RF) ablation. A custom‐made device allowed the separate assessment of fluoroscopy deployed from the control and examination room. Using conventional EP criteria, identification of the underlying substrate was possible in all but 4 noninducible patients (no accessory pathway [AP], no dual atrioventricular [AV] node): APs were present in 10 patients, AV node re‐entrant tachycardia in 26 patients, and ectopic atrial tachycardia in 1 patient. Despite 3 patients, in which switching to conventional ablation was necessary (8%), all others were successfully treated using the MNS. Overall fluoroscopy amounted to a median of 3.4 minutes (interquartile range, 2.4–5.3) with only a median of 1.0 minute exposure for the investigator.</jats:p><jats:p> <jats:italic>Conclusions:</jats:italic> Remote catheter ablation of SVT using the new MNS Niobe and a single conventional diagnostic catheter is feasible. Compared to conventional EP studies, a reduction of radiation exposure for both patients and investigators was demonstrated.</jats:p>
Nakagawa H, Antz M, Wong T, et al., 2007, Initial experience using a forward directed, high-intensity focused ultrasound balloon catheter for pulmonary vein antrum isolation in patients with atrial fibrillation., J Cardiovasc Electrophysiol., Vol: 18, Pages: 136-144
BACKGROUND: A high-intensity-focused ultrasound balloon catheter (HIFU-BC) is designed to isolate pulmonary veins (PV) outside the ostia (PV antrum). This catheter uses a parabolic CO2 balloon (behind water balloon) to focus a 20-, 25-, or 30-mm diameter ring of ultrasound forward of the balloon (parallel to catheter shaft). The purpose of this study is to test the safety and efficacy of the HIFU-BC for PV antrum isolation in patients with atrial fibrillation (AF). METHODS AND RESULTS: Twenty-seven patients with paroxysmal (19 patients) or persistent (8 patients) AF were studied. Double transseptal puncture was performed for left atrial deployment of a Lasso catheter (for PV mapping) and the 14 Fr HIFU-BC. The HIFU-BC was positioned outside the PV orifice over a guidewire. HIFU energy (acoustic power 45 watts) was applied for 40 seconds with a 20-mm sonicating ring and 40 or 60 seconds with a 25-mm or 30-mm sonicating ring. No other ablation system was utilized. PV antrum isolation was attempted using HIFU-BC in 78 of 104 PVs (25/27 RSPVs, all 23 LSPVs, all 23 LIPVs, all four left common trunks and 3/27 RIPVs). HIFU-BC successfully isolated 68 (87%) of the 78PV antra with 1-26 (median 3) HIFU applications. The complications include transient bleeding from a distal branch of the left superior PV resulting from guidewire manipulation in one patient and right phrenic nerve injury in another patient. No PV stenosis (>50% narrowing) and no LA-esophageal fistula occurred. At the 12-month follow-up, 16 (59%) of the 27 patients were free of symptomatic episodes of AF (only 3 of the 16 patients were receiving antiarrhythmic medications). CONCLUSIONS: Forward-focused HIFU applications isolated PVs outside the PV ostium with elimination of AF in 16 (59%) of the 27 patients at 12 months following the single ablation procedure.
SCHNEIDER C, ERNST S, BAHLMANN E, et al., 2006, Transesophageal echocardiography: A screening method for pulmonary vein stenosis after catheter ablation of atrial fibrillation, European Journal of Echocardiography, Vol: 7, Pages: 447-456, ISSN: 1525-2167
HUANG HE, WANG X, CHUN J, et al., 2006, A Single Pulmonary Vein as Electrophysiological Substrate of Paroxysmal Atrial Fibrillation, Journal of Cardiovascular Electrophysiology, Vol: 17, Pages: 1193-1201, ISSN: 1045-3873
<jats:p> <jats:italic>Introduction:</jats:italic> It has been demonstrated that pulmonary veins (PVs) play an important role in initiation and maintenance of paroxysmal atrial fibrillation (AF). However, it is not clearly known whether a single PV acts as electrophysiological substrate for paroxysmal AF.</jats:p><jats:p> <jats:italic>Methods and Results:</jats:italic> This study included five patients with paroxysmal AF. All patients underwent complete PV isolation with continuous circular lesions (CCLs) around the ipsilateral PVs guided by a three‐dimensional mapping system. Irrigated radiofrequency (RF) delivery was performed during AF on the right‐sided CCLs in two patients and on the left‐sided CCLs in three patients. The incomplete CCLs resulted in a change from AF to atrial tachycardia (AT), which presented with an identical atrial activation sequence and P wave morphology. Complete CCLs resulted in AF termination with persistent PV tachyarrhythmias within the isolated PV in all five patients. PV tachyarrhythmia within the isolated PV was PV fibrillation from the left common PV (LCPV) in two patients, PV tachycardia from the right superior PV (RSPV) in two patients, and from the left superior PV in one patient. All sustained PV tachyarrhythmias persisted for more than 30 minutes, needed external cardioversion for termination in four patients and a focal ablation in one patient. After the initial procedure, an AT from the RSPV occurred in a patient with PV fibrillation within the LCPV, and was successfully ablated.</jats:p><jats:p> <jats:italic>Conclusion:</jats:italic> In patients with paroxysmal AF, sustained PV tachyarrhythmias from a single PV can perpetuate AF. Complete isolation of all PV may provide good clinical outcome during long‐term follow‐up.</jats:p>
SCHMIDT B, ERNST S, OUYANG F, et al., 2006, External and Endoluminal Analysis of Left Atrial Anatomy and the Pulmonary Veins in Three‐Dimensional Reconstructions of Magnetic Resonance Angiography: The Full Insight from Inside, Journal of Cardiovascular Electrophysiology, Vol: 17, Pages: 957-964, ISSN: 1045-3873
<jats:p> <jats:italic>Introduction:</jats:italic> The detailed knowledge of the individual pulmonary vein (PV) anatomy may help to prevent serious complications during PV isolation (PVI). The purpose of this study was to determine the geometry of the PV ostia and their spatial relation to adjacent structures in external (ex 3D) and endoluminal (en 3D) three‐dimensional reconstructions of magnetic resonance angiographies (MRAs).</jats:p><jats:p> <jats:italic>Methods and Results:</jats:italic> Ex 3D and en 3D of the left atrium (LA) and the PVs of 28 patients were calculated. Diameters and the shape of PV ostia were assessed. In addition, the distances between ipsilateral PV ostia, the LA isthmus line, the roof line and the distance between the left PV and the LA appendage (LAA) were measured. Both ex 3D and en 3D are useful tools to determine the dimensions and the geometry of PVs. En 3D facilitates the identification of common PV ostia (15/28 patients). In en 3D, ipsilateral PV ostia are separated by a narrow myocardial ridge of less than 4 mm in 19/38 PVs (mean 4.3 ± 1 mm; 4.6 ± 2 mm with ex 3D). LAA and the LPV ostia are separated by a ridge of less than 4 mm in 12/28 PVs measured with en 3D (4.8 ± 2 mm; 6.4 ± 2 mm with ex 3D).</jats:p><jats:p> <jats:italic>Conclusions:</jats:italic> Both ex 3D and en 3D reconstructions of MRA precisely visualize the complex LA anatomy. Exact determination of PV ostial geometry is facilitated with en 3D and provides important anatomical information for the PVI strategy. According to our data, individual encircling of every PV is strongly discouraged.</jats:p>
Ernst S, Kuck K-H, 2006, Therapie des Vorhofflimmerns - das Ziel ist Rhythmuskontrolle, DMW - Deutsche Medizinische Wochenschrift, Vol: 131, Pages: 2158-2158, ISSN: 0012-0472
Ouyang F, Ma J, Ho SY, et al., 2006, Focal atrial tachycardia originating from the non-coronary aortic sinus -: Electrophysiological characteristics and catheter ablation, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 48, Pages: 122-131, ISSN: 0735-1097
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Chun JK-R, Ernst S, Matthews S, et al., 2006, Remote-controlled catheter ablation of accessory pathways: results from the magnetic laboratory, European Heart Journal, Vol: 28, Pages: 190-195, ISSN: 0195-668X
Ouyang F, Ernst S, Chun J, et al., 2005, Electrophysiological Findings During Ablation of Persistent Atrial Fibrillation With Electroanatomic Mapping and Double Lasso Catheter Technique, Circulation, Vol: 112, Pages: 3038-3048, ISSN: 0009-7322
<jats:p> <jats:bold> <jats:italic>Background—</jats:italic> </jats:bold> Pulmonary veins (PVs) can be completely isolated with continuous circular lesions (CCLs) around the ipsilateral PVs. However, electrophysiological findings have not been described in detail during ablation of persistent atrial fibrillation (AF). </jats:p> <jats:p> <jats:bold> <jats:italic>Methods and Results—</jats:italic> </jats:bold> Forty patients with symptomatic persistent AF underwent complete isolation of the right-sided and left-sided ipsilateral PVs guided by 3D mapping and double Lasso technique during AF. Irrigated ablation was initially performed in the right-sided CCLs and subsequently in the left-sided CCLs. After complete isolation of both lateral PVs, stable sinus rhythm was achieved after AF termination in 12 patients; AF persisted and required cardioversion in 18 patients. In the remaining 10 patients, AF changed to left macroreentrant atrial tachycardia in 6 and common-type atrial flutter in 4 patients. All atrial tachycardias were successfully terminated during the procedure. Atrial tachyarrhythmias recurred in 15 of 40 patients at a median of 4 days after the initial ablation. A repeat ablation was performed at a median of 35 days after the initial procedure in 14 patients. During the repeat study, recovered PV conduction was found in 13 patients and successfully abolished by focal ablation of the conduction gap of the previous CCLs. After a mean of 8±2 months of follow-up, 38 (95%) of the 40 patients were free of AF. </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> In patients with persistent AF, CCLs can result in either AF termination or con
LIU X, OUYANG F, MAVRAKIS H, et al., 2005, Complete pulmonary vein isolation guided by three-dimensional electroanatomical mapping for the treatment of paroxysmal atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy, Europace, Vol: 7, Pages: 421-427, ISSN: 1099-5129
ERNST S, HACHIYA H, CHUN JKR, et al., 2005, Remote Catheter Ablation of Parahisian Accessory Pathways Using a Novel Magnetic Navigation System—A Report of Two Cases, Journal of Cardiovascular Electrophysiology, Vol: 16, Pages: 659-662, ISSN: 1045-3873
<jats:p> <jats:italic>Introduction:</jats:italic> Ablation of anteroseptal (parahisian) pathways may be difficult using conventional catheters.</jats:p><jats:p> <jats:italic>Methods and Results:</jats:italic> Two patients (51 and 20 years old) underwent ablation of a parahisian accessory pathway using the magnetic navigation system Niobe<jats:sup>®</jats:sup> (Stereotaxis, Inc.), which consists of two external permanent magnets (0.08 Tesla) that steer a small magnet embedded in the tip of the ablation catheter. A motor drive allows the advancement or retraction of the catheter. From the control room, the ablation was performed using a single radiofrequency current application (fluoroscopy 3.2 and 6.0 minutes, respectively).</jats:p><jats:p> <jats:italic>Conclusions:</jats:italic> The Niobe magnetic navigation system was successfully used to perform completely remote controlled mapping and ablation of parahisian accessory pathways.</jats:p>
Ouyang F, Antz M, Ernst S, 2005, Recovered Pulmonary Vein Conduction as a Dominant Factor for Recurrent Atrial Tachyarrhythmias After Complete Circular Isolation of the Pulmonary Veins. Lessons From Double Lasso Technique, ACC Current Journal Review, Vol: 14, Pages: 33-33, ISSN: 1062-1458
Hachiya H, Iesaka Y, Ernst S, et al., 2005, Topographic distribution of focal left atrial tachycardias defined by electrocardiographic and electrophysiological data, Heart Rhythm, Vol: 2, Pages: S237-S237, ISSN: 1547-5271
Ouyang F, Antz M, Ernst S, et al., 2005, Recovered Pulmonary Vein Conduction as a Dominant Factor for Recurrent Atrial Tachyarrhythmias After Complete Circular Isolation of the Pulmonary Veins, Circulation, Vol: 111, Pages: 127-135, ISSN: 0009-7322
<jats:p> <jats:bold> <jats:italic>Background—</jats:italic> </jats:bold> Atrial tachyarrhythmias (ATa) can recur after continuous circular lesions (CCLs) around the ipsilateral pulmonary veins (PVs) in patients with atrial fibrillation (AF). This study characterizes the electrophysiological findings in patients with and without ATa after complete PV isolation. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods and Results—</jats:italic> </jats:bold> Twenty-nine of 100 patients had recurrent ATa after complete PV isolation by use of CCLs during a mean follow-up of ≈8 months. A repeat procedure was performed in 26 patients with ATa and in 7 volunteers without ATa at 3 to 4 months after CCLs. No recovered PV conduction was demonstrated in the 7 volunteers, whereas recovered PV conduction was found in 21 patients with recurrent ATa (right-sided PVs in 9 patients and left-sided PVs in 16 patients). The interval from the onset of the P wave to the earliest PV spike was 157±66 ms in the right-sided PVs and 149±45 ms in the left-sided PVs. During the procedure, PV tachycardia activated the atrium and resulted in atrial tachycardia (AT) in 10 patients. All conduction gaps were successfully closed with segmental RF ablation. After PV isolation, macroreentrant AT was induced and ablated in 3 patients. In the 5 patients without PV conduction, focal AT in the left atrial roof in 2 patients and non-PV foci in the left atrium in 1 patient were successfully abolished; in the remaining 2 patients, no ablation was performed because of noninducible arrhythmias. During a mean follow-up of ≈6 months, 24 patients were free of ATa without antiarrhythmic drugs. </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusio
Hachiya H, Ernst S, Ouyang F, et al., 2005, Topographic Distribution of Focal Left Atrial Tachycardias Defined by Electrocardiographic and Electrophysiological Data, Circulation Journal, Vol: 69, Pages: 205-210, ISSN: 1346-9843
Ouyang F, Bansch D, Ernst S, et al., 2004, Complete Isolation of Left Atrium Surrounding the Pulmonary Veins, Circulation, Vol: 110, Pages: 2090-2096, ISSN: 0009-7322
<jats:p> <jats:bold> <jats:italic>Background—</jats:italic> </jats:bold> Paroxysmal atrial fibrillation (PAF) can be eliminated with continuous circular lesions (CCLs) around the pulmonary veins (PVs), but it is unclear whether all PVs are completely isolated. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods and Results—</jats:italic> </jats:bold> Forty-one patients with symptomatic PAF underwent 3D mapping, and all PV ostia were marked on the 3D map based on venography. Irrigated radiofrequency energy was applied at a distance from the PV ostia guided by 2 Lasso catheters placed within the ipsilateral superior and inferior PVs. The mean radiofrequency duration was 1550±511 seconds for left-sided PVs and 1512±506 seconds for right-sided PVs. After isolation, automatic activity was observed in the right-sided PVs in 87.8% and in the left-sided PVs in 80.5%. During the procedure, a spontaneous or induced PV tachycardia (PVT) with a cycle length of 189±29 ms was observed in 19 patients. During a mean follow-up of 6 months, atrial tachyarrhythmias recurred in 10 patients. Nine patients underwent a repeat procedure. Conduction gaps in the left CCL in 9 patients and in the right CCL in 2 patients were closed during the second procedure. A spontaneous PVT with a cycle length of 212±44 ms was demonstrated in 7 of 9 patients, even though no PVT had been observed in 6 of these 7 patients during the first procedure. No AF recurred in 39 patients after PV isolation during follow-up. </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> Automatic activity and fast tachycardia within the PVs could reflect an arrhythmogenic substrat
Ernst S, Ouyang F, Linder C, 2004, Initial experience with remote catheter ablation using a novel magnetic navigation system. Magnetic remote catheter ablation, ACC Current Journal Review, Vol: 13, Pages: 51-52, ISSN: 1062-1458
Ernst S, Ouyang F, Linder C, et al., 2004, Initial Experience With Remote Catheter Ablation Using a Novel Magnetic Navigation System, Circulation, Vol: 109, Pages: 1472-1475, ISSN: 0009-7322
<jats:p> <jats:bold> <jats:italic>Background—</jats:italic> </jats:bold> Catheters are typically stiff and incorporate a pull-wire mechanism to allow tip deflection. While standing at the patient’s side, the operator manually navigates the catheter in the heart using fluoroscopic guidance. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods and Results—</jats:italic> </jats:bold> A total of 42 patients (32 female; mean age, 55±15 years) underwent ablation of common-type (slow/fast) or uncommon-type (slow/slow) atrioventricular nodal reentrant tachycardia (AVNRT) with the use of the magnetic navigation system Niobe (Stereotaxis, Inc). It consists of 2 computer-controlled permanent magnets located on opposite sides of the patient, which create a steerable external magnetic field (0.08 T). A small magnet embedded in the catheter tip causes the catheter to align and to be steered by the external magnetic field. A motor drive advances or retracts the catheter, enabling complete remote navigation. Radiofrequency current was applied with the use of a remote-controlled 4-mm, solid-tip, magnetic navigation–enabled catheter (55°C, maximum 40 W, 60 seconds) in all patients. The investigators, who were situated in the control room, performed the ablation using a mean of 7.2±4.7 radiofrequency current applications (mean fluoroscopy time, 8.9±6.2 minutes; procedure duration, 145±43 minutes). Slow pathway ablation was achieved in 15 patients, whereas slow pathway modulation was the end point in the remaining patients. There were no complications. </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> The Niobe magnetic n
Ernst S, 2004, Modulation of the slow pathway in the presence of a persistent left superior caval vein using the novel magnetic navigation system Niobe, Europace, Vol: 6, Pages: 10-14, ISSN: 1099-5129
Ernst S, Ouyang F, Linder C, et al., 2004, Initial experience with remote catheter ablation using a novel magnetic navigation system, Circulation, Vol: 109, Pages: 1472-1475
Bansch D, Oyang F, Antz M, et al., 2003, Successful Catheter Ablation of Electrical Storm After Myocardial Infarction, Circulation, Vol: 108, Pages: 3011-3016, ISSN: 0009-7322
<jats:p> <jats:bold> <jats:italic>Background—</jats:italic> </jats:bold> We report on 4 patients (aged 57 to 77 years; 3 men) who developed drug-refractory, repetitive ventricular tachyarrhythmias after acute myocardial infarction (MI). All episodes of ventricular arrhythmias were triggered by monomorphic ventricular premature beats (VPBs) with a right bundle-branch block morphology (RBBB). </jats:p> <jats:p> <jats:bold> <jats:italic>Methods and Results—</jats:italic> </jats:bold> Left ventricular (LV) mapping was performed to attempt radiofrequency (RF) ablation of the triggering VPBs. Activation mapping of the clinical VPBs demonstrated the earliest activation in the anteromedial LV in 1 patient and in the inferomedial LV in 2 patients. Short, high-frequency, low-amplitude potentials were recorded that preceded the onset of each extrasystole by a maximum of 126 to 160 ms. At the same site, a Purkinje potential was documented that preceded the onset of the QRS complex by 23 to 26 ms during sinus rhythm. In 1 patient, only pace mapping was attempted to identify areas of interest in the LV. Six to 30 RF applications abolished all local Purkinje potentials at the site of earliest activation and/or perfect pace mapping and suppressed VPBs in all patients. No episode of ventricular tachycardia or fibrillation has recurred for 33, 14, 6, and 5 months in patients 1, 2, 3, and 4, respectively. </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> Incessant ventricular tachyarrhythmias after MI may be triggered by VPBs. RF ablation of the triggering VPBs is feasible and can prevent drug-resistant electrical storm, even after acute MI. Catheter ablation of
Ernst S, Ouyang F, Clausen C, et al., 2003, A model for <i>in vivo</i> validation of linear lesions in the right atrium, JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY, Vol: 9, Pages: 259-268, ISSN: 1383-875X
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Ouyang F, Antz M, Deger FT, et al., 2003, An Underrecognized Subepicardial Reentrant Ventricular Tachycardia Attributable to Left Ventricular Aneurysm in Patients With Normal Coronary Arteriograms, Circulation, Vol: 107, Pages: 2702-2709, ISSN: 0009-7322
<jats:p> <jats:bold> <jats:italic>Background—</jats:italic> </jats:bold> In patients with apparently normal hearts, ventricular tachycardia (VT) may only involve the subepicardial myocardium. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods and Results—</jats:italic> </jats:bold> Four patients with exercise-induced fast VT with right bundle branch block morphology were investigated. ECG showed a small q wave in leads II, III, and aVF during sinus rhythm (SR) in all 4 patients. Left ventricular angiography showed small inferolateral aneurysms in all patients. Coronary arteriograms were normal in all 4 patients. Six unstable VTs (cycle length, 200 to 305 ms) and 1 stable VT (cycle length 370 ms) were reproducibly induced in the 4 patients. During SR, endocardial mapping was normal in all 4 patients, and epicardial mapping showed fragmented and late potentials in the left inferolateral wall anatomically consistent with the left ventricle aneurysm. During tachycardia, epicardial mapping showed a macroreentrant VT with focal endocardial activation in the patient with stable VT, whereas in 2 patients with unstable VT, a diastolic potential was only recorded and coincided with the late potential in the same area. Epicardial ablation was performed in 3 patients and successfully abolished those VTs. No VT recurred in 2 patients during follow-up of 2 and 9 months. Clinical VT recurred 6 months after the ablation and was successfully ablated in a repeated epicardial ablation in 1 patient. In the remaining patient without epicardial ablation, an implantable cardiac defibrillator was implanted. There were multiple shocks during a follow-up of 31 months. </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:it
ERNST S, OUYANG F, GOYA M, et al., 2003, Total Pulmonary Vein Occlusion as a Consequence of Catheter Ablation for Atrial Fibrillation Mimicking Primary Lung Disease, Journal of Cardiovascular Electrophysiology, Vol: 14, Pages: 366-370, ISSN: 1045-3873
<jats:p> <jats:bold> <jats:italic>Introduction:</jats:italic> Catheter ablation has recently been used for curative treatment of atrial fibrillation.</jats:bold> </jats:p><jats:p> <jats:bold> <jats:italic>Methods and Results:</jats:italic> Three of 239 patients who underwent ablation close to the pulmonary vein (PV) ostia at our institute developed severe hemoptysis, dyspnea, and pneumonia as early as 1 week and as late as 6 months after the ablation. Because the patients were arrhythmia‐free, the treating physician initially attributed the symptoms to new‐onset pulmonary disease (e.g., bronchopulmonary neoplasm). After absent PV flow was confirmed by transesophageal echocardiography, transseptal contrast injection depicted a totally occluded PV in all three patients. Successful recanalization, even in chronically occluded Pvs, was performed in all patients. During follow‐up, Doppler flow measurements by transesophageal echocardiography demonstrated restenosis in all primarily dilated PV, which led to stent implantation.</jats:bold> </jats:p><jats:p> <jats:bold> <jats:italic>Conclusion:</jats:italic> PV stenosis/occlusion after catheter ablation of atrial fibrillation occurs in a subset of patients. However, because in‐stent restenosis occurred in two patients after 6 to 10 weeks, final interventional strategy for PV stenosis or occlusion remains unclear. To prevent future PV stenosis or occlusion, a decrease in target temperature and energy of radiofrequency current or the use of new energy sources (ultrasound, cryothermia, microwave) seems necessary.</jats:bold> <jats:italic>(J Cardiovasc Electrophysiol, Vol. 14, pp. 366‐370, April 2003)</jats:italic> </jats:p>
Ernst S, Ouyang F, Loeber F, et al., 2003, Catheter-induced linear lesions in the left atrium in patients with atrial fibrillation - an electroanatomical study, J Am Coll Cardiol, Vol: 42, Pages: 1271-1282
Goya M, Ouyang F, Ernst S, et al., 2002, Electroanatomic Mapping and Catheter Ablation of Breakthroughs From the Right Atrium to the Superior Vena Cava in Patients With Atrial Fibrillation, Circulation, Vol: 106, Pages: 1317-1320, ISSN: 0009-7322
<jats:p> <jats:bold> <jats:italic>Background—</jats:italic> </jats:bold> The superior vena cava (SVC) is one of the sources of ectopies that can initiate atrial fibrillation (AF). We investigated by radiofrequency ablation the electrophysiological characteristics of the junction of the right atrium (RA) and the SVC and the feasibility of electrical disconnection of the SVC from the RA. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods and Results—</jats:italic> </jats:bold> Sixteen patients with paroxysmal AF after pulmonary vein isolation underwent electroanatomic mapping at the RA–SVC junction during sinus rhythm. Mapping showed sharp potentials (SVC potentials) inside the SVC. Activation spread from the earliest SVC potential (breakthrough) to the rest of the SVC. SVC potentials were found over a large amount of the circumference, suggesting widespread muscle coverage of the SVC. Breakthroughs from the RA to SVC were located anteriorly, laterally, posteriorly, and septally in 3, 4, 10, and 6 patients, respectively. The number of breakthroughs was 1.4±0.5 per patient. Radiofrequency energy was applied with the end point of electrical disconnection. All breakthroughs were eliminated with 3.1±1.7 applications per breakthrough without complications. </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> SVC potentials can be recorded inside the SVC. There are specific breakthroughs from the RA to the SVC that can be identified by electroanatomic mapping. The electrical disconnection of the SVC from the RA is feasible. </jats:p>
Ouyang F, Ernst S, Vogtmann T, 2002, Characterization of reentrant circuits in left atrial macroreentrant tachycardia. critical isthmus block can prevent atrial tachycardia recurrence, ACC Current Journal Review, Vol: 11, Pages: 76-76, ISSN: 1062-1458
Ouyang F, Cappato R, Ernst S, 2002, Electroanatomic substrate of idiopathic left ventricular tachycardia. Unidirectional block and macroreentry within the Purkinje network, ACC Current Journal Review, Vol: 11, Pages: 87-87, ISSN: 1062-1458
Ouyang F, Fotuhi P, Ho SY, 2002, Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp. Electrocardiographic characterization for guiding catheter ablation, ACC Current Journal Review, Vol: 11, Pages: 86-87, ISSN: 1062-1458
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