Effect Of Pulmonary Vein Isolation Research Articles

Different Effects of Pulmonary Vein Isolation on Quality of Life Between Patients with Persistent and Paroxysmal Atrial Fibrillation.

The effect of restoring sinus rhythm by pulmonary vein isolation (PVI) on the quality of life (QOL) of patients with persistent atrial fibrillation (PerAF) has not been adequately investigated. This study was performed to compare the changes in QOL after extended PVI between patients with PerAF and paroxysmal AF (PAF).Patients with PAF (n = 38) and PerAF (n = 22) who underwent their first PVI and developed no AF recurrence 6 months after PVI were enrolled. QOL surveys were performed at baseline and 6 months post-ablation using Short Form-36 surveys.The mental component summary score (MCS) (53.4 ± 10.2 to 56.5 ± 7.1, P = 0.019) and physical component summary score (PCS) (46.1 ± 10.6 to 48.5 ± 8.3, P = 0.015) improved after PVI in the PAF group. The PCS, but not the MCS, improved after PVI in the PerAF group (45.8 ± 7.9 to 51.5 ± 6.2, P < 0.001). Changes in the PCS were greater in the PerAF group than in the PAF group (8.6 ± 6.9 versus 2.8 ± 5.2, P = 0.009). Multivariate regression analysis demonstrated that a low baseline MCS and the type of AF (PAF) were independent predictors of an increased MCS and that a low baseline PCS and the type of AF (PerAF) were independent predictors of an increased PCS.The changes in QOL differed between PAF and PerAF after PVI. Although most patients with PerAF were asymptomatic before PVI, their improvement in physical QOL was greater than that in patients with PAF. Such beneficial effects on physical QOL are likely expected in patients with PerAF with a low PCS before PVI.

Cardiac autonomic regulation in patients undergoing pulmonary vein isolation for atrial fibrillation.

Ablation procedures for the treatment of atrial fibrillation lead to changes in autonomic heart control; however, there are insufficient data on the possible association of these changes with atrial fibrillation recurrence. The study aim was to assess the effects of pulmonary vein isolation (PVI) on cardiac autonomic modulation and atrial fibrillation recurrence. We screened 52 patients with atrial fibrillation referred for PVI, of whom 20 patients met inclusion and exclusion criteria, and were enrolled in the study and followed over 6 months. Beat-to-beat blood pressure monitoring was performed 1-2 days before PVI, 1 and 6 months after PVI. We estimated pulse interval variability and spontaneous baroreflex sensitivity (BRS) both in the time and frequency domains, and performed the Valsalva manoeuvre assessing the Valsalva ratio. During 6 months after PVI, atrial fibrillation recurrence was observed in six patients. One month after PVI, pulse interval variability and BRS (sequence method) significantly decreased in all patients, returning to preintervention values by 6 months. Patients without atrial fibrillation recurrence at 1 month showed a transient reduction in pulse interval variability (frequency domain) and in BRS (both methods) in contrast to those with atrial fibrillation recurrence. A significant decrease in the Valsalva ratio observed at 1 month was maintained at 6 months after PVI in both groups. Successful PVI may lead to transient autonomic alterations reflected by a reduction in pulse interval variability and BRS, with more prolonged changes in the Valsalva ratio. The efficacy of PVI in preventing atrial fibrillation recurrence seems to be related to transient parasympathetic atrial denervation.

HOLTER MONITORING AND ECHOCARDIOGRAPHY FOR PREDICTING THE EFFECTIVENESS OF PULMONARY VIEN ISOLATION IN PATIENTS WITH PAROXYSMAL AND PERSISTENT ATRIAL FIBRILLATION

Aim. To evaluate the impact of the atrial ectopic activity and left ventricular diastolic dysfunction on predicting the effectiveness of pulmonary vein isolation (PVI) in patients with paroxysmal and persistent atrial fibrillation (AF).Methods. 54 patients with paroxysmal and persistent AF and the normal left ventricular ejection fraction were included in the study. Patients underwent Holter monitoring and echocardiography prior to the intervention to identify the predictors of successful PVI. The follow-up was 12 months after the indexed procedure. The effectiveness of treatment was assessed from the third month of the postoperative period. The criterion of the successful treatment was the absence of the AF paroxysms lasting more than 30 seconds, confirmed by Holter, diurnal and / or multi-day monitoring. The Student's t-test was used to assess the reliability of the differences between the variables characterizing the treatment results in the study groups. The discriminant analysis was performed to develop an algorithm that allows predicting the PVI result. A p value &lt;0.05 was considered statistically significant.Results. Premature atrial contraction over 70 per hour can be considered as the predictor of the successful PVI in patients with normal left atrial size. The severe LA enlargement should be considered as a predictor of poor ablation efficacy. The obtained discriminant function allows predicting the effectiveness of PVI in patients with paroxysmal and persistent AF depending on Holter monitoring and echocardiography. Its sensitivity is high for both predicting success and failure of the intervention.Conclusion. Holter monitoring and echocardiography allow predicting the effectiveness of PVI. The intervention's efficacy in the groups of patients with severe LA enlargement and the combination of normal left atrial size with over 70 PAC per hour should be addressed in the further studies.

Effect of pulmonary vein isolation on left atrial appendage flow in paroxysmal atrial fibrillation

Left atrial appendage (LAA) functional modification in the context of pulmonary vein isolation has been a focus point of research and LAA emptying flow velocity (LAAEFV) is considered to reflect LAA contractility, stunning, and fibrosis. In the present study, we sought to prospectively evaluate short-term LAAEFV changes after radiofrequency (RF) or cryoballoon ablation in paroxysmal AF. This was a prospective substudy of the Effect of Cryoballoon and RF Ablation on Left Atrial Function (CryoLAEF) study (ClinicalTrials.gov Identifier: NCT02611869). Thirty patients, randomly assigned to RF or cryoablation, were prospectively followed. Transesophageal echocardiograms were performed at baseline and at 3 months postablation to measure LAAEFV. All measurements were performed in sinus rhythm. Overall, LAAEFV was 44.2 [38.5-62.8] cm/s at baseline and was increased to 70.8 [64.8-77.6] cm/s at 3 months' postablation (P<0.001). Baseline LAAEFV was 52.5 [37.7-68.0] cm/s in the RF group and 42.8 [38.7-52.9] cm/s in the CryoBalloon group (P=0.653). At 3 months, the corresponding values were 68.5 [61.9-76.6] cm/s and 73.9 [69.2-79.9] cm/s, respectively (P=0.081 for the difference between the two groups at 3 months). The median change in LAAEFV was 11.0 [4.7-26.2] cm/s in the RF group versus 29.6 [15.8-37.0] cm/s in the CryoBalloon group (P=0.033). LAA function is improved after catheter ablation with RF or balloon cryoablation in patients with paroxysmal AF, evaluated while in sinus rhythm both at baseline and on follow-up.

Pulmonary vein anatomy variants as a biomarker of atrial fibrillation \u2013 CT angiography evaluation

BackgroundIt has been suggested that changes in pulmonary veins (PV) and left atrium (LA) anatomy may have an influence on initiating atrial fibrillation (AF) and the effectiveness of pulmonary vein isolation (PVI) in patients (pts) with atrial fibrillation.The aim of the study was to assess anatomy abnormalities of the PV and LA in the patients with the history of AF and compare it with the control group(CG).MethodsThe multi-slice tomography (MSCT) scans were performed in 224 AF pts. before PVI (129 males, mean age 59 ± 9 yrs). The CG consisted of 40 pts. without AF (26 males, age 45 ± 9 yrs). LA and PV anatomy were evaluated. Diameters of PV ostia were measured in two directions: anterior-posterior (AP) and superior-inferior (SI) automatically using Vitrea 4.0.ResultsPulmonary veins anatomy variants were observed more frequently in the atrial fibrillation group - 83 pts. (37%) vs 6 pts. (15%) in CG; 9% (21 pts) left common ostia (CO), 2% (5 pts) right CO, 19% (42 pts) additional right PV (APV), (1.8%) 4 pts. APV left, 8% right early branching (EB) and 3.5% left EB. The LA diameter differed significantly in AF vs CG group (41.2 ± 6 mm vs 35 ± 4.2 mm, p < 0.0001) respectively.ConclusionsThe anomalies of pulmonary vein anatomy occurred more often in pts. with AF. They can be defined as an image biomarkers of atrial fibrillation. Right additional (middle) pulmonary vein was the most important anomaly detected in AF patients as well as enlargered diameters of the LA and PV ostia.

Variability in pulmonary vein electrophysiology and fibrosis determines arrhythmia susceptibility and dynamics.

Success rates for catheter ablation of persistent atrial fibrillation patients are currently low; however, there is a subset of patients for whom electrical isolation of the pulmonary veins alone is a successful treatment strategy. It is difficult to identify these patients because there are a multitude of factors affecting arrhythmia susceptibility and maintenance, and the individual contributions of these factors are difficult to determine clinically. We hypothesised that the combination of pulmonary vein (PV) electrophysiology and atrial body fibrosis determine driver location and effectiveness of pulmonary vein isolation (PVI). We used bilayer biatrial computer models based on patient geometries to investigate the effects of PV properties and atrial fibrosis on arrhythmia inducibility, maintenance mechanisms, and the outcome of PVI. Short PV action potential duration (APD) increased arrhythmia susceptibility, while longer PV APD was found to be protective. Arrhythmia inducibility increased with slower conduction velocity (CV) at the LA/PV junction, but not for cases with homogeneous CV changes or slower CV at the distal PV. Phase singularity (PS) density in the PV region for cases with PV fibrosis was increased. Arrhythmia dynamics depend on both PV properties and fibrosis distribution, varying from meandering rotors to PV reentry (in cases with baseline or long APD), to stable rotors at regions of high fibrosis density. Measurement of fibrosis and PV properties may indicate patient specific susceptibility to AF initiation and maintenance. PV PS density before PVI was higher for cases in which AF terminated or converted to a macroreentry; thus, high PV PS density may indicate likelihood of PVI success.

Adenosine triphosphate/adenosine guided pulmonary vein isolation does not improve the outcomes of ablation: a meta-analysis of randomized controlled trials

ABSTRACTBackground: Successful pulmonary vein isolation (PVI) is the most reliable predictor of success after ablation in patients with atrial fibrillation (AF). Adenosine triphosphate (ATP) unmasks the dormant conduction and can be used to improve the effectiveness of PVI. The impact of ATP guided PVI on clinical outcomes is discordant in various randomized controlled trials (RCTs).Objectives: To delineate the incremental benefit of ATP during PVI in patients with AF through a meta-analysis.Methods and results: Database searches through January 2017 identified 5 RCTs (enrolling 2839 patients) comparing ATP guided PVI versus standard PVI (non-ATP). Four trials exclusively studied paroxysmal AF while one trial included both paroxysmal and non-paroxysmal AF patients. Baseline characteristics, dose of adenosine and ablation strategies were clearly identified among all the trials. The risk ratio (RR) for AF episodes lasting >30 s after 3-month blanking period was calculated with random effects meta-analysis and showed no difference at a median follow up of 12 months [RR: 1.02, 95 % Confidence interval (CI): 0.85 to 1.25; p = 0.82]. Similarly, the number of repeat ablation was similar in both groups [RR: 1.02, 95 % CI: 0.63, 1.56; p = 0.98].Conclusions: ATP guided PVI does not decrease the recurrence of AF or the need for repeat ablation at 12 months.

IMPACT OF PULMONARY VEIN ISOLATION ON HOSPITALIZATIONS IN HEART FAILURE WITH PRESERVED EJECTION FRACTION

Atrial fibrillation (AF) is common in patients with heart failure with preserved ejection fraction (HFpEF) and may portend negative prognostic value. The effect of pulmonary vein isolation (PVI) on heart failure outcomes such as hospitalizations in such patients is unknown. Patients with HFpEF (

Automated lesion annotation during pulmonary vein isolation: influence on acute isolation rates and lesion characteristics.

Recovery of pulmonary vein (PV) conduction is a common mechanism of atrial fibrillation recurrence after PV isolation (PVI), underscoring the need for durable lesion formation. We aimed to evaluate the utility of an automated lesion annotation algorithm (ALAA) on acute isolation rates and resulting lesion characteristics. Fifty patients underwent PVI using a contact force (CF) sensing catheter and ALAA. Single antral circles around ipsilateral PVs were performed with ALAA-1 settings including catheter stability (range of motion ≤2mm, duration >10s). Target CF was 10-20g but not part of ALAA-1 settings. If PV conduction persisted after circle completion, force over time was added to automated settings (ALAA-2). Emerging gaps were subsequently ablated, followed by re-assessment for PVI. ALAA-1 isolated 70% of the left and 78% of the right PVs using 756.3 ± 212.3s (left) and 737.1 ± 145.9s (right) of energy delivery. ALAA-2 settings identified 29 gaps in previously unisolated PVs, closure significantly increased isolation rates to 88% of the left and 96% of the right PVs with additional 325.4 ± 354.1s (left) and 266.8 ± 279.5s (right) of energy delivery (p = 0.001). Lesion characteristics significantly differed between ALAA-1 (n = 3521 lesions) and ALAA-2 (n = 3037 lesions) settings, and between isolated and non-isolated PV segments, particularly with respect to CF. Interlesion distances with ALAA-2 were significantly longer in the left superior, left superior-anterior, and right superior-posterior segments when compared to ALAA-1. Settings of an ALAA affect lesion characteristics reveal areas of insufficient lesion formation and influence acute effectiveness of PVI. Combination of CF and stability shows superior performance over stability alone.

Clinical impact of contact force and its regional variability on efficiency and effectiveness of pulmonary vein isolation for atrial fibrillation

BackgroundThe purpose of this study is to analyze the impact of average contact force (CF) and its regional variability during pulmonary vein isolation (PVI) for atrial fibrillation (AF) on periprocedural parameters and midterm outcome. MethodsThis retrospective cohort study enrolled 57 drug-refractory AF patients who underwent initial PVI for AF using an open-irrigated CF catheter (SmartTouch Thermocool, Biosense Webster, Diamond Bar, CA, USA). Thirty patients were assigned to a lower CF (LCF) group (average CF≤10g) and 27 patients to a higher CF (HCF) group (average CF>10g). The relationship between CF and clinical outcome was analyzed. ResultsPatients were followed-up for 317±57 days after PVI. The CF was 8.1±1.3g in the LCF group and 12.4±1.5g in the HCF group. Higher average CF was associated with shorter ablation time (28±6min vs. 36±9min, p=0.0002) and lower radiofrequency energy delivery (79±18 vs. 99±26, p=0.0016) for PVI. The rate of acute PV reconnection (APVR) was similar in both groups (LCF group 60% vs. HCF group 44%, p=0.36). Four patients (13%) in the LCF group and nine patients (33%) in the HCF group experienced AF-recurrence. Average CF did not impact on AF-recurrence during midterm clinical outcome (p=0.09 by log-rank test). In the non-recurrence group (n=44), average CF was higher at left posterosuperior PV and right anteroinferior PV than that in the recurrence group (n=13) (p=0.012 and p=0.004, respectively). ConclusionsHigher average CF decreased ablation time and radiofrequency energy delivery for PVI, but did not decrease APVR rate or improve midterm clinical outcome.

Quality of life in patients with paroxysmal atrial fibrillation after circumferential pulmonary vein ablation.

Atrial fibrillation (AF) is the most common arrhythmia and is associated with a deterioration of quality of life (QoL). Catheter ablation is a therapeutic strategy for some patients with AF. The effectiveness of pulmonary vein isolation is still under assessment. To assess the long-term influence of circumferential pulmonary vein ablation (CPVA) on QoL in patients with AF. The study population consisted of 33 patients (26 males, age 54.2 ± 9 years) with highly symptomatic (EHRA II-III) drug refractory paroxysmal AF, who underwent CPVA. A clinical examination, electrocardiogram (ECG), and Holter ECG were performed before and during a one-year follow-up. The SF-36 Medical Outcomes Survey Short-Form QoL questionnaire, scored on a 0-100 scale for each of eight domains: bodily pain (BP), general health (GH), mental health (MH), physical functioning (PF), role-emotional (RE), role-physical (RP), social functioning (SF), and vitality (V), was collected before and one year after CPVA. In the one-year follow-up 27 (82%) patients were free of AF. EHRA symptoms were improved one-year after CPVA regardless of CPVA efficacy. After the follow-up the SF-36 questionnaire results improved significantly in all of the subscales in patients without a recurrence of AF after CPVA. In subjects with a recurrence of AF, all of the subscales did not indicate any statistically significant differences. There was an association between the CPVA and the following QoL domains: GH (p = 0.018), PF (p = 0.042), and V (p = 0.041). The highest values of the GH and V domains were found in the non-recurrence patients one year after CPVA. CPVA results in the clinical improvement of patients with symptomatic AF regardless of the final arrhythmia termination. Patients after successful CPVA experienced a significant improvement in all of the subscales of the QoL.

Atrial fibrillation: to map or not to map?

Isolation of the pulmonary veins may be an effective treatment modality for eliminating atrial fibrillation (AF) episodes but unfortunately not for all patients. When ablative therapy fails, it is assumed that AF has progressed from a trigger-driven to a substrate-mediated arrhythmia. The effect of radiofrequency ablation on persistent AF can be attributed to various mechanisms, including elimination of the trigger, modification of the arrhythmogenic substrate, interruption of crucial pathways of conduction, atrial debulking, or atrial denervation. This review discusses the possible effects of pulmonary vein isolation on the fibrillatory process and the necessity of cardiac mapping in order to comprehend the mechanisms of AF in the individual patient and to select the optimal treatment modality.

第15回体表心臓微小電位研究会 シンポジウムP波加算平均心電図の臨床的意義 心房細動患者に対するカテーテル・アブレーションの再発の予測:P波加算平均心電図を用いた検討.

第15回体表心臓微小電位研究会 シンポジウムP波加算平均心電図の臨床的意義 心房細動患者に対するカテーテル・アブレーションの再発の予測:P波加算平均心電図を用いた検討.

GEOMETRICAL REVERSE REMODELING OF LEFT ATRIUM AFTER ATRIAL FIBRILLATION ABLATION

Background: Pulmonary vein isolation (PVI) induces left atrial (LA) volume reduction, so-called reverse remodelling (RR). However, the related changes in LA geometry have not yet been evaluated. LA sphericity is a marker of atrial remodelling in patients with atrial ibrillation (AF) and is a powerful predictor of PVI success. The aim of the study was to evaluate the effect of PVI on LA sphericity and describe the spherical RR process.

AFAF (Autonomic Function in Atrial Fibrillation) Study: The Effect of Pulmonary Vein Isolation (PVI) for Atrial Fibrillation (AF) on Autonomic Reflexes

AFAF (Autonomic Function in Atrial Fibrillation) Study: The Effect of Pulmonary Vein Isolation (PVI) for Atrial Fibrillation (AF) on Autonomic Reflexes

Comparative effectiveness of catheter ablation strategies for rhythm control in patients with atrial fibrillation: a meta-analysis

Pulmonary vein isolation (PVI) forms the basis of catheter ablation strategies for atrial fibrillation (AF). Ablation of additional sites has been used to increase the efficacy of ablation procedures in restoring and maintaining normal sinus rhythm. The aim of this paper was to compare the effectiveness of PVI versus PVI plus adjuvant atrial ablations (PVI+) in patients with AF. A systematic search using bibliographic databases and gray literature was undertaken. Randomized and non-randomized controlled trials evaluating clinical efficacy, effectiveness, or safety of ablation procedures in adults with AF were included in this review. Of 3,204 potential citations identified by the original search, 21 randomized controlled trials and three non-randomized trials were included. Meta-analysis results reveal that in the first year after ablation, AF patients who underwent PVI+ strategies had a significantly higher rate of maintaining sinus rhythm than those who underwent PVI alone (RR 1.10, 95% CI 1.02, 1.17). However, a subgroup meta-analysis was statistically significant for only PVI+ left atrial (LA) linear ablations (RR 1.16, 95% CI 1.04, 1.29). The pooled success rates were higher in PVI+ group for both paroxysmal (RR 1.14, 95% CI 1.06, 1.24) and non-paroxysmal AF (RR 1.53, 95% CI 1.10, 2.14). PVI+ strategies, particularly PVI+ LA ablations, appear to result in higher success rates than PVI alone in the first year after the procedure. Studies of longer duration are needed to evaluate the long-term benefits and safety of different adjunctive ablation approaches for rhythm control in AF patients.

Mitral regurgitation recovery and atrial reverse remodeling following pulmonary vein isolation procedure in patients with atrial fibrillation: a proof of concept cardiac MRI study

Summary Atrial reverse remodeling triggered by favorable pulmonary vein isolation for atrial fibrillation results in regression of mitral regurgitation. Background Atrial fibrillation (AF) is a chronic and progressive disease, and if uncontrolled results in permanent remodeling of the myocardium. Reverse remodeling of the left atrium (LA) after the successful pulmonary vein isolation (PVI) in recurrent/chronic AF may occur, however, mitral regurgitation (MR) recovery after the successful PVI has not been demonstrated but would be an important factor in PVI durability. Objective Retrospectively analyze the effectiveness of pulmonary vein isolation (PVI) procedure in patients with AF for evidence of atrial reverse remodeling and recovery of MR via CMR. Methods Prior to PVI, patients underwent a clinically indicated CMRI, post-PVI (6±1months) patients underwent a follow up MRI, and were classified into 2 groups: responders (R) to PVI, non responders (NR) to PVI as assessed by cessation of AF at the end of 3 month blanking period. Further, CMR was used to evaluate the severity of MR (0 to 4+) and to relate changes in MR to LA, LAA volumes as well as mitral apparatus (mitral annulus, tenting area, tenting height and tenting angle). For continuous variables, group differences were assessed by unpaired or paired two-sample t tests or their non-parametric equivalents. We used chi-square tests for evaluating categorical variables. Results Of the 94 patients with AF who underwent PVI, 76 (81%) were classified as R and 18 (19%) were classified as NR. Mean age, mean BSA and antiarrhythmic therapies were similar between the groups. MR pre vs. post in the R group significantly improved (Mean 0.78, Median 1.0 vs. Mean 0.51, Median 0, P 0.01) and was matched by favorable mitral geometry reverse remodeling [annulus (34.5 ± 3.9 mm vs. 32.6 ± 3.9 mm, p <0.001), tenting area (169.7 ± 55.9 mm2 vs. 139.0 ± 40.6 mm2, p < 0.001), and tenting height (8.0 ±2.0 mm vs. 7.2 ± 1.8 mm, p <0.001), tenting angle (128° ± 11° vs. 130° ± 10°)]. However, in the NR group MR failed to improve (Mean 1.06 Med 1.0 vs. Mean 0.67 Med 0, p NS), and paralleled failure of mitral geometry reverse remodeling [annulus (33.1 ± 4.0 mm vs. 32.9 ± 3.6 mm, p NS), tenting area (154. 0 ± 42.0 mm2 vs. 143.9 ± 45.4 mm2, p NS), tenting height (6.9 ± 1.9 mm vs. 7.0 ± 1.8, p NS), tenting angle (131° ± 11 vs. 130° ± 10°)]. Likewise, LVESD, LVEF, LA volume, and RA volumes pre to post PVI favorably improved in the R group but not in NR (table 1). Conclusions Long-term success rate in AF patients following PVI remains suboptimal. In those with successful and

Clinical Outcome of Catherter Ablation for Atrial Fibrillation Resistant to Combination Therapy of Bepridil and Aprindine

Background: It is known that additional catheter ablation (CA), including electrogram-based ablation, right isthmus ablation, and so forth, after pulmonary vein isolation (PVI) improve outcome of atrial fibrillation (AF). We investigate the effect of PVI and additional CA for refractory AF patients. Methods: We studied consecutive 33 patients (27 males, 63±11 years, paroxysmal AF 46%, persistent AF 54%) who underwent PVI for AF resistant to combination therapy of Bepridil and Aprindine (Bep+Apr). They were divided into 2 groups, 23 patients with both PVI and additional CA (group A) and 10 patients with PVI alone (group B). We evaluated the relationship between AF recurrence and anti-arrhythmic agents after CA in 2 groups. Results: During 413±435 follow-up days, recurrences of AF in the group B were observed more frequently than those in the group A (70% vs 26%, P=0.02). Moreover, the dosage of both Bepridil and Aprindine in the group A were lower compared with those in the group B (88±51 vs 180±25 mg, P=0.02, 31mg±11 mg vs 44±8 mg, P=0.04, respectively). Conclusions: The present findings suggest that PVI with additional CA improve recurrence rate of refractory AF, leading to reduce the dosage of anti-arrhythmic agents after CA.

The Efficacy of Pulmonary Vein Isolation for Two Cases of Persistent Atrial Fibllilation with Atrial Septal Defect

Aim: Pulmonary Vein Isolation (PVI) has been performed for cure non-valviler atrial fibllilation (AF) cases. It is not clear the effect of PVI for AF with congenital heart disease. We studied the efficacy of PVI for two cases of persistent AF with atrial septal defect (ASD) Case 1: 62 y.o. male. He had pointed arrhythmia, and consulted the hospital because of dyspnea. He had been diagnosed ASD and persistent AF. LVEF was 30%. AF was converted to sinus rhythm under Amiodarone. After PVI, Paroxysmal AF (PAF) was observed, but sinus rhythm was maintained without Amiodarone and LV systoric function improved to normal. He will undergo catheter ASD closing operation after second PVI. Case 2: 52 y.o. female. She had been diagnosed ASD and PAF. She was admitted because of CHF with persistent AF and hyperthyroidism. Persistent AF was converted to sinus rhythm by electrical defibrillation under Beprijil at euthyroidism. After first PVI AF recurrence was not observed, but LA-PV conductions ware maintained at second PVI. After second PVI AF recurrence was not observed with Bepridil. She will undergo catheter ASD closing operation. Conclusions: PVI for AF with ASD were seems to be good procedure before catheter ASD closing operation.

Clinical effectiveness of pulmonary vein isolation for arrhythmic events in a patient with catecholaminergic polymorphic ventricular tachycardia

An 18-year-old woman with catecholaminergic polymorphic ventricular tachycardia (CPVT) underwent pulmonary vein isolation (PVI) because of frequent and inappropriate shocks from an implantable cardioverter defibrillator (ICD) associated with atrial fibrillation (AF) with a rapid ventricular response. While the PVI did not completely suppress the AF induced by an isoproterenol infusion, the Holter monitor recordings demonstrated a major decrease in the clinical episodes of AF and ventricular tachyarrhythmias in association with a reduced high-frequency (HF) component and ratio of the low-frequency (LF) component power to the HF component (LF/HF) after the PVI. The PVI can decrease the substrates that trigger and maintain the AF when it involves a pulmonary vein origin, and may exert an additional effect on the sympathetic nerve input to the heart. The PVI may be an adjunctive therapy for CPVT cases with drug refractory AF causing inappropriate ICD discharges.