Role of Pulmonary Vein in Atrial Fibrillation
Abstract
Background. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in1–2% of the general population and likely to increase in next 50 years. The prevalence of AF increases with age, from 0.5% at40–50 years, to 5–15% at 80 years. Precise mechanisms that lead tothe onset and persistence of AF have not completely been elucidated.The key role of ectopic foci in pulmonary veins as a trigger of AF has been recognized. Depending on disease progression, 60 to95% of triggers responsible for AF induction originate within the pulmonary veins (PV).
Because of the clinical importance of the PVs in the initiation of AF, it makes the increasingly widespread application of catheter ablation techniques in these veins as a treatment for AF. Restoration and maintenance of sinus rhythm is of potential benefit if it can be achieved without the use of anti arrhythmic drugs, and this fact underscores the need to strive for the development of non pharmacological treatments to achieve and maintain sinus rhythm.
Objective. The aim of the presentation is to discuss about role of pulmonary vein potential isolation on treatment of atrial fibrillation.
Summary. A 64 year old man with diagnosis of paroxysmal atrial fibrillation was reported. The patient was then performed catheter ablation using CARTO 3D electroanatomic mapping system. He underwent pulmonary vein isolation and had successful result. In paroxysmal AF, PV electrical isolation remains a pivotal strategy. It is associated with arrhythmia suppression without the use of anti arrhythmic agents. The clinical outcome of ablation can further improved.
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References
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Sanders P, Hocini M, Jais P, et al. Pulmonary vein isolation for atrial ablation. In: Huang S, Wood MA, eds. Catheter ablation od cardiac arrhythmias. Philadelphia: Elsevier; 2006:269-87.
Aldhoon B, Melenovsky V, Peichl P, Kautzner J. New insights into mechanism of atrial fibrillation. Physiol Res 2010;59:1-12.
Weber S, Ndrepepa G, Schneider M, Deisenhofer I, Zrenner B, Schmitt C. Electrophysiological differences of the spontaneous onset of paroxysmal and persistent atrial fibrillation. Pacing Clin Electrophysiol 2007;30:295-303.
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Hassink RJ, Aretz HT, Ruskin J, Keane D. Morphology of atrial myocardium in human pulmonary veins: a postmortem analysis in patients with and without atrial fibrillation. J Am Coll Cardiol 2003;42:1108-14.
Tagawa M, Higuchi K, Chinushi M, et al. Myocardiumextend-ing from the left atrium onto the pulmonary veins: a comparison between subjects with and without atrial fibrillation. Pacing Clin Electrophysiol 2001;24:1459-63.
Roux N, Havet E, Mertl P. The myocardial sleeves of the pul-monary veins: potential implications for atrial fibrillation. Surg Radiol Anat 2004;26:285-89.
Hamabe A, Okuyama Y, Miyauchi Y, et al. Correlation between anatomy and electrical activation in canine pulmonary veins. Circulation 2003;107:1550-5.
Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659-66.
Ehrlich J, Nattel S. Electrophysiological basis ofatrial fibrillation. In: Schwartzman D, Zenati M, eds. Innovative management of atrial fibrillation. Massachusets: Blackwell; 2005:3-18.
Calkins H, Brugada J, Packer DL, et al. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Ar-rhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace 2007;9:335-79.
Haissaguerre M, Shah DC, Jais P, et al. Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation 2000;102:2463-5.
Pappone C, Rosanio S, Oreto G, et al. Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation. Circulation 2000;102:2619-28
Sanders P, Hocini M, Jais P, et al. Pulmonary vein isolation for atrial ablation. In: Huang S, Wood MA, eds. Catheter ablation od cardiac arrhythmias. Philadelphia: Elsevier; 2006:269-87.
Aldhoon B, Melenovsky V, Peichl P, Kautzner J. New insights into mechanism of atrial fibrillation. Physiol Res 2010;59:1-12.
Weber S, Ndrepepa G, Schneider M, Deisenhofer I, Zrenner B, Schmitt C. Electrophysiological differences of the spontaneous onset of paroxysmal and persistent atrial fibrillation. Pacing Clin Electrophysiol 2007;30:295-303.
Calkins H, Siew Y. Ho J, Cabrera A, et al. Anatomy of the eft atrium an pulmonary veins. In: Natale A, Raviele A, eds. Atrial Fibrillation Ablation : the state of the art based on the venicechart international consensus document. USA: Blackwell Publishing Inc; 2007:1-10.
Hassink RJ, Aretz HT, Ruskin J, Keane D. Morphology of atrial myocardium in human pulmonary veins: a postmortem analysis in patients with and without atrial fibrillation. J Am Coll Cardiol 2003;42:1108-14.
Tagawa M, Higuchi K, Chinushi M, et al. Myocardiumextend-ing from the left atrium onto the pulmonary veins: a comparison between subjects with and without atrial fibrillation. Pacing Clin Electrophysiol 2001;24:1459-63.
Roux N, Havet E, Mertl P. The myocardial sleeves of the pul-monary veins: potential implications for atrial fibrillation. Surg Radiol Anat 2004;26:285-89.
Hamabe A, Okuyama Y, Miyauchi Y, et al. Correlation between anatomy and electrical activation in canine pulmonary veins. Circulation 2003;107:1550-5.
Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659-66.
Ehrlich J, Nattel S. Electrophysiological basis ofatrial fibrillation. In: Schwartzman D, Zenati M, eds. Innovative management of atrial fibrillation. Massachusets: Blackwell; 2005:3-18.
Calkins H, Brugada J, Packer DL, et al. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Ar-rhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace 2007;9:335-79.
Haissaguerre M, Shah DC, Jais P, et al. Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation 2000;102:2463-5.
Pappone C, Rosanio S, Oreto G, et al. Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation. Circulation 2000;102:2619-28
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How to Cite
Munawar, D., & Yuniadi, Y. (1). Role of Pulmonary Vein in Atrial Fibrillation. Indonesian Journal of Cardiology, 33(4), 236-43. https://doi.org/10.30701/ijc.v33i4.30
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Case Reports
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