Thoracic vein ablation terminates chronic atrial fibrillation in dogs

1 Division of Cardiology, Department of Medicine, and 2 Division of Cardiothoracic Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles 90048-1865; and 3 Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif...

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Published in:American journal of physiology. Heart and circulatory physiology 2004-06, Vol.286 (6), p.H2072-H2077
Main Authors: Park, Angela M, Chou, Chung-Chuan, Drury, Paul C, Okuyama, Yuji, Peter, Anish, Hamabe, Akira, Miyauchi, Yasushi, Kass, Robert M, Karagueuzian, Hrayr S, Fishbein, Michael C, Lin, Shien-Fong, Chen, Peng-Sheng
Format: Article
Language:English
Subjects:
Animals
Atrial Fibrillation - etiology
Atrial Fibrillation - physiopathology
Atrial Fibrillation - surgery
Catheter Ablation
Chronic Disease
Dogs
Electric Stimulation
Electrodes
Female
Myocardium - pathology
Pacemaker, Artificial
Pulmonary Veins - physiology
Pulmonary Veins - surgery
Vena Cava, Superior - physiology
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Summary:1 Division of Cardiology, Department of Medicine, and 2 Division of Cardiothoracic Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles 90048-1865; and 3 Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California 90095-1679 Submitted 2 July 2003 ; accepted in final form 4 January 2004 The thoracic vein hypothesis of chronic atrial fibrillation (AF) posits that rapid, repetitive activations from muscle sleeves within thoracic veins underlie the mechanism of sustained AF. If this is so, thoracic vein ablation should terminate sustained AF and prevent its reinduction. Six female mongrel dogs underwent chronic pulmonary vein (PV) pacing at 20 Hz to induce sustained (>48 h) AF. Bipolar electrodes were used to record from the atria and thoracic veins, including the vein of Marshall, four PVs, and the superior vena cava. Radio frequency (RF) application was applied around the PVs and superior vena cava and along the vein of Marshall until electrical activity was eliminated. Computerized mapping (1,792 electrodes, 1 mm resolution) was also performed. Sustained AF was induced in 30.6 ± 6.5 days, and ablation was done 17.3 ± 8.5 days afterward. Before ablation, the PVs had shorter activation cycle lengths than the atria, and rapid, repetitive activations were observed in the PVs. All dogs converted to sinus rhythm during ( n = 4 dogs) or within 90 min of completion of RF ablation. Rapid atrial pacing afterward induced only nonsustained (
ISSN:0363-6135
1522-1539
DOI:10.1152/ajpheart.00595.2003