Original Article
Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins
N Engl J Med 1998; 339:659-666September 3, 1998
- Abstract
Background
Atrial fibrillation, the most common sustained cardiac arrhythmia and a major cause of stroke, results from simultaneous reentrant wavelets. Its spontaneous initiation has not been studied.
Methods
We studied 45 patients with frequent episodes of atrial fibrillation (mean [±SD] duration, 344±326 minutes per 24 hours) refractory to drug therapy. The spontaneous initiation of atrial fibrillation was mapped with the use of multielectrode catheters designed to record the earliest electrical activity preceding the onset of atrial fibrillation and associated atrial ectopic beats. The accuracy of the mapping was confirmed by the abrupt disappearance of triggering atrial ectopic beats after ablation with local radio-frequency energy.
Results
A single point of origin of atrial ectopic beats was identified in 29 patients, two points of origin were identified in 9 patients, and three or four points of origin were identified in 7 patients, for a total of 69 ectopic foci. Three foci were in the right atrium, 1 in the posterior left atrium, and 65 (94 percent) in the pulmonary veins (31 in the left superior, 17 in the right superior, 11 in the left inferior, and 6 in the right inferior pulmonary vein). The earliest activation was found to have occurred 2 to 4 cm inside the veins, marked by a local depolarization preceding the atrial ectopic beats on the surface electrocardiogram by 106±24 msec. Atrial fibrillation was initiated by a sudden burst of rapid depolarizations (340 per minute). A local depolarization could also be recognized during sinus rhythm and abolished by radio-frequency ablation. During a follow-up period of 8±6 months after ablation, 28 patients (62 percent) had no recurrence of atrial fibrillation.
Conclusions
The pulmonary veins are an important source of ectopic beats, initiating frequent paroxysms of atrial fibrillation. These foci respond to treatment with radio-frequency ablation.
Media in This Article
Figure 2
Angiogram of a Left Inferior Pulmonary Vein Depicting the Source and Exit of Ectopic Activity.Figure 1
Diagram of the Sites of 69 Foci Triggering Atrial Fibrillation in 45 Patients.Article Activity
- Article
Atrial fibrillation is the most common of all sustained cardiac arrhythmias, with the prevalence increasing with age to up to 5 percent in persons more than 65 years of age, and it is a major cause of stroke.1-3 Experimental studies and human surgical mapping studies have shown that atrial fibrillation is perpetuated by reentrant wavelets propagating in an abnormal atrial-tissue substrate.4-8 Complex approaches have been developed to interrupt wavelets, including extensive surgical or, recently, catheter-mediated atriotomy.9-21 There are, however, no data about the spontaneous initiation of atrial fibrillation. The triggers of atrial fibrillation may be focal targets for ablative therapy. We investigated the mode of initiation of spontaneous paroxysms of human atrial fibrillation by atrial ectopic beats, the characteristics of these triggering beats, and the effects of local ablation with radio-frequency energy.
Methods
Characteristics of the Patients
The study population consisted of 45 patients enrolled consecutively (Table 1Table 1
Characteristics of the Patients.) who met the following criteria: the patient had to have atrial fibrillation resistant to more than two drugs, there had to be at least one episode of atrial fibrillation every two days, the patient had to be receiving anticoagulant treatment, the patient had to have frequent isolated atrial ectopic beats (more than 700 per 24 hours), and the patient had to provide informed consent. The protocol was approved by the hospital's safety committee. Antiarrhythmic drugs were discontinued two to five days before hospitalization; amiodarone was being taken by nine patients.The patients were monitored by telemetry throughout their hospital stays. Before ablation, atrial fibrillation occurred daily in 39 patients and every two days in the other 6 patients, with a mean (±SD) duration of 344±326 minutes per 24 hours. Twelve-lead electrocardiographic recordings were obtained to document the morphologic features of the ectopic beats. In 37 patients, at least one instance of initiation of sustained atrial fibrillation lasting more than one minute was documented: the ectopic beat initiating atrial fibrillation had a short coupling interval (a P-on-T pattern) and morphologic features similar to those of isolated ectopic beats. Their identical origin was confirmed later by intracardiac mapping data.
Electrophysiologic Study
Oral anticoagulants were replaced on admission by either subcutaneous or intravenous heparin to maintain a partial-thromboplastin time of 60 to 90 seconds (control, 30 seconds). Heparin was stopped four to six hours before ablation, since transseptal catheterization was sometimes required.
Three multielectrode catheters were introduced percutaneously through the femoral veins: one quadripolar roving ablation catheter with a thermocouple and a 4-mm tip, one catheter in the right atrial appendage (for right atrial and right-pulmonary-vein foci) or coronary sinus (for left-pulmonary-vein foci) to provide stable reference electrograms during mapping, and one catheter for stimulation.22,23 In three patients, two roving catheters were used to map two pulmonary veins simultaneously. Surface electrocardiographic leads (I, II, III, and V1) and bipolar intracardiac electrograms filtered at 30 to 500 Hz were recorded with a polygraph (Midas, PPG Biomedical Systems, Lenexa, Kans.).
Stimuli were adjusted to be twice the diastolic threshold and 2 msec in duration. If the arrhythmia did not spontaneously develop during electrophysiologic monitoring or was not sufficiently sustained, physiologic procedures (e.g., Valsalva's maneuver or carotid-sinus massage), atrial pacing, pharmacologic agents (e.g., isoproterenol, adenosine triphosphate, digoxin, propranolol, or verapamil), or all three methods were used.
Localization of Arrhythmogenic Triggers (Atrial Ectopic Beats)
The preliminary study involved intracardiac mapping of isolated ectopic beats. The ectopic focus was localized according to the earliest atrial activity relative to the reference electrogram or the onset of the ectopic P wave. Mechanically produced beats were prevented by avoiding manipulation of the catheters during the recordings, and such beats were excluded from the analysis by comparing the electrocardiographic pattern and intracardiac sequence with the confirmed spontaneous ectopic beats. If no sharp bipolar activity was recorded in the right atrium earlier than 10 msec before the onset of the ectopic P wave, the ectopic beats were considered to have originated in the left atrium. Direct mapping of the left atrium and pulmonary veins was performed through a patent foramen ovale (in six patients) or by means of transseptal catheterization. In the anteroposterior view, the pulmonary-vein ostia are situated on both sides of the spine and can be engaged by applying clockwise torque to the shaft of the catheter. The role of ectopic beats in the initiation of atrial fibrillation was confirmed by on-site recording of a paroxysm of fibrillation.
Ablation Procedure
No heparin was administered for ablation in the right atrium. For the left atrium, an intravenous dose of 0.5 mg of heparin per kilogram of body weight was administered during ablation, followed by an infusion to maintain a partial-thromboplastin time of 60 to 90 seconds. The sedatives midazolam and nalbuphine were administered intravenously to control pain.
Ablation was performed at the site with the earliest recorded ectopic activity. To minimize the risk of clot formation, temperature-controlled radio-frequency energy was delivered at a target temperature of 70°C in the right atrium or 55 to 60°C in the left atrium between the catheter electrode and a patch electrode measuring 575 cm2 for 60 to 120 seconds, except when there was a rise in impedance.24,25
Subcutaneous heparin was administered after ablation to maintain the partial-thromboplastin time. Successful ablation was defined as the elimination of atrial triggers during the 60 minutes after ablation and the absence of the morphologic features of the targeted ectopic beats during the subsequent eight days without a need for antiarrhythmic drugs.
Telemetry and 24-hour Holter monitoring were performed continuously, and the data were monitored by nurses to identify the cumulative duration of atrial fibrillation and the duration of fibrillation during each hour. The patients were discharged and given oral anticoagulants for at least three months but no antiarrhythmic drugs. Late follow-up consisted of visits to the hospital and Holter recordings every three months. Any undocumented but suggestive symptoms were attributed to atrial fibrillation.
Statistical Analysis
Continuous variables were expressed as group means ±SD and were compared with the use of the Kruskal–Wallis test. Statistical significance was considered to be demonstrated by a two-tailed P value of less than 0.05.
Results
Origin of Atrial Triggers (Ectopic Beats)
A single point of origin of ectopic beats was identified in 29 patients, two were identified in 9 patients, three were identified in 6 patients, and four in 1 patient, for a total of 69 ectopic foci. Ectopic beats originated in atrial muscle (“atrial foci”) in 4 patients (in the right atrium in 3 and the posterior left atrium in 1) and in the pulmonary veins (“venous foci”) in 41 patients (a total of 65 foci [94 percent]): 31 foci in the left superior, 17 in the right superior, 11 in the left inferior, and 6 in the right inferior pulmonary vein (Figure 1Figure 1
Diagram of the Sites of 69 Foci Triggering Atrial Fibrillation in 45 Patients.). The venous origin of the earliest ectopic activity was demonstrated in 23 patients by the radiographic position of the mapping catheter, which was superimposed on the lungs and was outside the cardiac silhouette, and by confirmatory angiographic visualization.Characteristics of Triggering Ectopic Beats Arising in the Pulmonary Veins
The effective mapping of venous foci required multiple procedures because of two major problems. First, the spontaneous occurrence of ectopic beats and paroxysms of atrial fibrillation was unpredictable, and provocative procedures were not consistently effective. Second, sustained atrial fibrillation lasting for minutes or hours required either waiting periods for spontaneous interruption or cardioversion. In five patients, there were no isolated ectopic beats during mapping, because each ectopic beat set off atrial fibrillation. Venous foci exhibited the characteristic electrophysiologic patterns described below.
Activity during Ectopy
The earliest local activity was traced to a point 2 to 4 cm within the main pulmonary vein or one of its proximal branches, and depolarization was marked by a “spike” (activity of sharp onset and short duration as measured electrographically) preceding the onset of the ectopic P wave by 106±24 msec (range, 40 to 160) (Figure 2Figure 2
Angiogram of a Left Inferior Pulmonary Vein Depicting the Source and Exit of Ectopic Activity.). The P wave was not distinct in six patients in whom only the reference electrogram was used for mapping. The spike was localized, and its amplitude rapidly decreased, when the catheter tip was turned or moved a few millimeters. Bystander or far-field activity from contiguous branches could be distinguished by temporal delay or lower amplitude (<0.1 mV). The spike occurred earliest deep in the vein and progressively later toward the ostium and the left atrial exit, resulting in distal-to-proximal venous activation during multipolar recordings (Figure 2). The amplitude of the unipolar electrograms of the spikes (<0.5 mV) was too low for morphologic analysis.A second electrographic component with a slow deflection (depolarization rate [dv/dt], <0.5 mV per msec) reflecting later left atrial activation was temporally distinct from the spike inside the vein and then approached and became continuous with the spike at the ostium. The conduction time from the venous spike to the activation of the left atrium increased progressively as the coupling interval of the spike spontaneously shortened and when there were repetitive spike discharges. Nonconducted spikes (those confined within the vein) were recorded in 21 patients. They were more closely coupled with the previous beat than the conducted spikes (183±29 msec vs. 207±29 msec, P=0.03), and a threshold coupling interval below which the spike was isolated could be identified in 19 patients.
Initiation of Atrial Fibrillation
Between one and eight instances of spontaneous initiation of atrial fibrillation were recorded in 36 patients. Two patients with atrial foci had atrial fibrillation induced after irregular atrial tachycardia, one with a mean cycle length of 230 msec and the other with a mean cycle length of 250 msec. In 34 patients with venous foci, the initiation of atrial fibrillation was documented for 45 of 58 foci with the use of a catheter in the appropriate vein. Atrial fibrillation was initiated by a single focal discharge in 3 patients (including 2 with structural heart disease), a short burst of two or more repetitive focal discharges in 40, and both mechanisms in 2 (Figure 3Figure 3
Two Examples of the Onset of Atrial Fibrillation from Foci in a Right Inferior Pulmonary Vein and a Left Superior Pulmonary Vein.). Repetitive focal discharges had irregular cycle lengths, ranging from 110 to 270 msec, with a mean of 175±30 msec (340 per minute). Five foci discharged only in bursts, with each burst producing atrial fibrillation. The coupling interval from the last sinus beat to the initial spike did not differ significantly between ectopic beats that led to atrial fibrillation and those that were isolated (212±34 msec vs. 216±34 msec). Continuous electrical activity could be recorded in the pulmonary vein during the interval between successive spikes but not during the period preceding the first spike.In nine patients, no spontaneous initiation of atrial fibrillation could be documented during mapping. However, all nine had frequent isolated ectopic beats originating from a single focus (atrial in two patients and venous in seven, all with similar characteristics) and previous electrocardiographic documentation of the role of these beats in initiating atrial fibrillation.
Activity during Sinus Rhythm
The spike could also be recognized during sinus rhythm in the terminal portions of local potentials after left atrial activity, and it occurred progressively later inside the vein, which is the opposite of the sequence during ectopy (Figure 2). Multiple spikes were recorded at the ostia, particularly those of the superior veins. Similar (though less complex) electrograms could also be recorded in other nonarrhythmogenic pulmonary veins (those not giving rise to ectopic beats), indicating physiologic activation of muscular left atrial tissue extending into the veins.26,27
Radio-Frequency Ablation
The four ectopic foci mapped to atrial muscle outside the pulmonary veins exhibited the earliest activity — 35 to 45 msec before the onset of the ectopic P wave — implying a short conduction time to the rest of the atrium. They were ablated with a median of 3 and a mean of 4.5±2 applications of radio-frequency energy in one session.
The ablation of venous foci was performed at the earliest site of the maximal amplitude of the spike during conducted or nonconducted ectopic beats. As shown in Table 2Table 2
Outcome of In-Hospital Ablation According to Location of Focus., two sessions were required for 25 patients and three sessions were required for 6 because of a recurrence after ablation or the detection of new foci. All but one recurrence occurred within three days of the initial procedure. A mean of 5±5 and a median of 4 applications of radio-frequency energy were required for each focus.No serious side effects were observed during these procedures. Cough was induced in some patients by applications of radio-frequency energy in the left superior veins near the bronchi and required the cessation of the delivery of radio-frequency energy or a reduction in power. Pain was sometimes severe, requiring additional doses of nalbuphine.
Electrograms recorded at the sites of successful ablation of 57 venous foci showed the disappearance of the local spike during sinus rhythm in 44 of the foci, an intermittent spike (every two or three beats) in 3, and dissociation from atrial activity as a slow automatic rhythm in 2 (Figure 4Figure 4
Effects of Successful Radio-Frequency Ablation within the Superior Pulmonary Veins in Two Patients.). At eight sites, the spike persisted, but with a lower amplitude and a delay of 10 to 50 msec.After ablation the angiograms of the pulmonary veins of 23 patients were unremarkable except for a luminal irregularity (possibly a small thrombus) in 1 patient. Twenty of the sites of successful ablation were located at or near a branching point.
Follow-up
Successful ablation of ectopic foci in the hospital was achieved in 38 patients. The Holter recordings of these patients showed a decrease from 4377±3629 to 98±91 ectopic beats per 24 hours. Two patients had a recurrence of atrial fibrillation, whereas 36 patients had no recurrences during hospitalization, including the 9 patients without initiation of atrial fibrillation during the ablation procedure. Ablation of the focus was unsuccessful in seven patients, and all had recurrences of atrial fibrillation in the hospital.
During a mean follow-up period of 8±6 months (median, 7), atrial fibrillation was eliminated completely in 28 patients (62 percent) without the use of drug therapy. Seventeen patients had recurrences of atrial fibrillation, including those who had early failures, and recurrences of ectopy were documented in 12 of these patients during hospitalization or follow-up.
Discussion
This study indicates that the vast majority of atrial premature beats that initiate frequent paroxysms of atrial fibrillation originate in the pulmonary veins. These foci trigger atrial fibrillation with a burst of rapid discharges and respond to local radio-frequency ablation with a catheter.
The pulmonary veins were identified as major sources of atrial triggers (ectopic beats) by means of intracardiac mapping, fluoroscopy, and angiographic imaging. Such venous foci were previously observed in a few patients who underwent atrial ablation for paroxysmal atrial fibrillation.20 In our study of patients who had not previously undergone ablation for atrial fibrillation, 94 percent of the atrial triggers originated in the pulmonary veins. This prevalence was similar to that in the subgroup of patients with structural heart disease, but a larger series is needed to confirm this result.
All the patients were enrolled because they had frequent and drug-resistant paroxysmal atrial fibrillation, and the high prevalence of foci in the pulmonary veins may therefore reflect an anatomical site or mechanism that is particularly arrhythmogenic and resistant to conventional drug therapy rather than the true prevalence in the general population with atrial fibrillation. In some patients, however, isolated ectopic beats could not be recorded during mapping, because of long-lasting atrial fibrillation requiring cardioversion, because no such beats were present, or both. This suggests that our methods and results could be applied to a broader range of clinical situations with the use of more reliable provocative procedures and simultaneous multielectrode mapping.
The pulmonary-vein foci exhibited unique characteristics, including deep venous origin, unpredictable firing, and complex, delayed conduction to the left atrium with frequent ectopic beats confined to the vein. A similar arrhythmia has been previously documented between the superior vena cava and the right atrium — again in a great vein–atrial junction.28 The deep venous origin contrasts with the juxtaostial origin of conventional left atrial tachycardias, and the long conduction time indicates either discontinuous conduction or a tissue several centimeters long, since the morphologic features of the spike indicate a rapidly conducting structure. A long conduction time was also reproduced by local venous pacing, but the effects of stimulation through pacing therapy have not been explored.20
The recording of spikes during sinus rhythm in other pulmonary veins reflects the physiologic activation of muscular bands extending from the left atrium to the venous wall with complex pathways.26,27,29,30 The predominant distribution of foci in the superior veins matches the dominant anatomical pattern of these atrial extensions.29 The reasons why pulmonary veins become arrhythmogenic are unknown. However, their architectural topography can accommodate various electrophysiologic mechanisms, notably automaticity, as indicated by dissociation after ablation in two patients, and reentry, as suggested by continuous activity between subsequent spikes. In contrast, the first spike was apparently linked to the previous sinus beat without there being any intervening activity, suggesting triggered automaticity as a possible mechanism.31 In perfused dog hearts, abnormal automaticity and various conduction disturbances have been demonstrated in the musculature of thoracic veins.28-30 In the literature, there are no data pertaining to the spontaneous initiation of atrial fibrillation in humans or animals, but a recent preliminary report indicates the arrhythmogenic role of pulmonary veins in dogs with congestive heart failure.32
In our patients, a train of repetitive rapid discharges (rate, 340 per minute) initiated atrial fibrillation, which then continued independently. Atrial fibrillation was in fact the result of the abrupt transformation of apparently benign isolated ectopic beats into a dangerous burst of rapid discharges, and ablation of these foci produced a concomitant dramatic decrease in the total number of ectopic beats and short-term recurrences of atrial fibrillation. In nine patients, isolated ectopic beats were used as a guide for ablation without mapping the initiation of atrial fibrillation. In some patients, the focus discharged only in bursts inducing fibrillation, without producing isolated ectopic beats. The short triggering burst differs from the “focal atrial fibrillation” observed in a few patients in whom a single focus fires for sustained periods without leading to typical intracardiac fibrillation owing to a near-normal substrate.23
The concept that paroxysms of atrial fibrillation are initiated by discharges from one or only a few focal sources has important implications. Repetitive discharges can produce progressive pathologic changes in the atrial substrate that may lead to the self-perpetuation of atrial fibrillation.33 The focus responds to curative therapy with minimal catheter ablation, which can suppress the trigger and may reduce the potential degeneration of the atrial substrate. This approach has the advantage over rate-control therapies of maintaining sinus rhythm, and its use may decrease the morbidity associated with other, more extensive curative procedures.9-20,34,35
The successful ablation of foci was safely achieved, and the procedure eliminated previously frequent atrial fibrillation without a need for antiarrhythmic drugs in 84 percent of the patients during hospital monitoring and in 62 percent after discharge. Of note, most of the recurrent atrial fibrillation was associated with recurrent ectopic beats, indicating that a better technique of mapping or of ablation may further improve these results. Important limitations inherent in the management of atrial fibrillation are the difficulty of obtaining reliable data on arrhythmia and its initiation on an outpatient basis and the uncertain duration of asymptomatic episodes.36 Additional studies are necessary to evaluate the role of ablation of triggering ectopic foci in preventing atrial fibrillation, as well as the safety of ablation in the pulmonary veins, before widespread application of ablation for the treatment of this common cardiac-rhythm disturbance can be recommended.
Source Information
From the Hôpital Cardiologique du Haut-Lévêque, Ave. de Magellan, 33604 Bordeaux-Pessac, France, where reprint requests should be addressed to Dr. Haïssaguerre.
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Hans Kottkamp, Hildegard Tanner, Richard Kobza, Petra Schirdewahn, Anja Dorszewski, Jin-Hong Gerds-Li, Corrado Carbucicchio, Christopher Piorkowski, Gerhard Hindricks. (2004) Time courses and quantitative analysis of atrial fibrillation episode number and duration after circular plus linear left atrial lesions. Journal of the American College of Cardiology 44:4, 869-877
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BENGT HERWEG, ARZU ILERCIL, DAVID M. WHITAKER, LYN HAMILTON, NADIM G. KHAN, S. SERGE BAROLD. (2004) Treatment of Sustained Left Atrial Tachycardia by Ostial Pulmonary Vein Isolation. Pacing and Clinical Electrophysiology 27:8, 1153-1157
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HAKAN ORAL, SRIKAR VEERAREDDY, ERIC GOOD, BURR HALL, PETER CHEUNG, KAMALA TAMIRISA, JIHN HAN, JACKIE FORTINO, AMAN CHUGH, FRANK BOGUN, FRANK PELOSI, FRED MORADY. (2004) Prevalence of Asymptomatic Recurrences of Atrial Fibrillation After Successful Radiofrequency Catheter Ablation. Journal of Cardiovascular Electrophysiology 15:8, 920-924
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SIMON P. FYNN, JOSEPH B. MORTON, VINCENT R. DEEN, PETER M. KISTLER, JITENDRA K. VOHRA, PAUL B. SPARKS, JONATHAN M. KALMAN. (2004) Conduction Characteristics at the Crista Terminalis During Onset of Pulmonary Vein Atrial Fibrillation. Journal of Cardiovascular Electrophysiology 15:8, 855-861
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QIN XI, ALAN V. SAHAKIAN, JASON NG, STEVEN SWIRYN. (2004) Atrial Fibrillatory Wave Characteristics on Surface Electrogram:. Journal of Cardiovascular Electrophysiology 15:8, 911-917
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Yoichi Kikuchi, Taku Sakurada, Masato Suzuki, Tomoyasu Hirano, Katsuyuki Kusajima. (2004) Epicardial radiofrequency ablation for chronic atrial fibrillation undergoing simultaneous on-pump beating coronary artery bypass grafting. The Japanese Journal of Thoracic and Cardiovascular Surgery 52:8, 375-378
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SHIH-ANN CHEN, CHING-TAI TAI. (2004) Is Analysis of Fibrillatory Waves Useful for Treatment of Atrial Fibrillation?. Journal of Cardiovascular Electrophysiology 15:8, 918-919
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SANJAY DIXIT, EDWARD P. GERSTENFELD, DAVID J. CALLANS, FRANCIS E. MARCHLINSKI. (2004) Mechanisms Underlying Sustained Firing From Pulmonary Veins:. Evidence From Pacing Maneuvers and Pharmacological Manipulation. Pacing and Clinical Electrophysiology 27:8, 1120-1129
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Paul A. Friedman, Stephen C. Hammill. (2004) Ablation of atrial fibrillation: are the lines drawn?. Heart Rhythm 1:2, 185-187
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DOUGLAS L. PACKER. (2004) Evolution of Mapping and Anatomic Imaging of Cardiac Arrhythmias. Pacing and Clinical Electrophysiology 27:7, 1026-1049
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Tim D Kinnaird, Orhan Uzun, Bradley I Munt, Christopher R Thompson, John A Yeung-Lai-Wah. (2004) Transesophageal echocardiography to guide pulmonary vein mapping and ablation for atrial fibrillation. Journal of the American Society of Echocardiography 17:7, 769-774
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Yoshito Inoue, Issei Kiso, Ryuichi Takahashi, Atsuo Mori, Kenta Motogami. (2004) Beating-heart epicardial radiofrequency ablation: optimal temperature setting. The Annals of Thoracic Surgery 78:1, 308-311
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Kristina Lemola, Burr Hall, Peter Cheung, Eric Good, Jihn Han, Kamala Tamirisa, Aman Chugh, Frank Bogun, Frank Pelosi, Fred Morady, Hakan Oral. (2004) Mechanisms of recurrent atrial fibrillation after pulmonary vein isolation by segmental ostial ablation. Heart Rhythm 1:2, 197-202
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Gregory K Feld. (2004) Catheter ablation of atrial fibrillation: what is the best technique for achieving a high cure rate with acceptable risk?. Journal of the American College of Cardiology 43:11, 2054-2056
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Brian Olshansky. (2004) Combining ablation of atrial fibrillation with ablation of atrial flutter: are we there yet?. Journal of the American College of Cardiology 43:11, 2063-2065
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Koichiro Kumagai, Masahiro Ogawa, Hiroo Noguchi, Tomoo Yasuda, Hideko Nakashima, Keijiro Saku. (2004) Electrophysiologic properties of pulmonary veins assessed using a multielectrode basket catheter. Journal of the American College of Cardiology 43:12, 2281-2289
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PETER CHEUNG, BURR HALL, AMAN CHUGH, ERIC GOOD, KRISTINA LEMOLA, JIHN HAN, KAMALA TAMIRISA, FRANK PELOSI, FRED MORADY, HAKAN ORAL. (2004) Detection of Inadvertent Catheter Movement into a Pulmonary Vein During Radiofrequency Catheter Ablation by Real-Time Impedance Monitoring. Journal of Cardiovascular Electrophysiology 15:6, 674-678
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Michel Haïssaguerre, Prashanthan Sanders, Mélèze Hocini, Pierre Jaïs, Jacques Clémenty. (2004) Pulmonary veins in the substrate for atrial fibrillation. Journal of the American College of Cardiology 43:12, 2290-2292
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STEFAN WEBER, GJIN NDREPEPA, MICHAEL SCHNEIDER, CLAUS SCHMITT. (2004) Two-to-one Conduction Block Between Left Atrium and Right Lower Pulmonary Vein Preceding Complete Vein Isolation During Radiofrequency Current Ablation. Pacing and Clinical Electrophysiology 27:6p1, 829-830
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Gustavo Glotz de Lima, Renato A.K Kalil, Tiago L.L Leiria, Domingos M Hatem, Claudio L Kruse, Rogério Abrahão, João R.M Sant'anna, Paulo R Prates, Ivo A Nesralla. (2004) Randomized study of surgery for patients with permanent atrial fibrillation as a result of mitral valve disease. The Annals of Thoracic Surgery 77:6, 2089-2094
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CHANDRASEKHAR R. VASAMREDDY, LARS LICKFETT, VINOD K. JAYAM, KHURRAM NASIR, DAVID J. BRADLEY, ZAYD ELDADAH, TIMM DICKFELD, RONALD BERGER, HUGH CALKINS. (2004) Predictors of Recurrence Following Catheter Ablation of Atrial Fibrillation Using an Irrigated-Tip Ablation Catheter. Journal of Cardiovascular Electrophysiology 15:6, 692-697
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HEMANTH RAMANNA, JACQUES M.T. DE BAKKER, ARIF ELVAN. (2004) On the Atrial Response to Focal Discharges in Man. Journal of Cardiovascular Electrophysiology 15:6, 629-636
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Koonlawee Nademanee, John McKenzie, Erol Kosar, Mark Schwab, Buncha Sunsaneewitayakul, Thaveekiat Vasavakul, Chotikorn Khunnawat, Tachapong Ngarmukos. (2004) A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. Journal of the American College of Cardiology 43:11, 2044-2053
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Antonio Pacifico, Philip D Henry. (2004) Ablation for atrial fibrillation: are cures really achieved?. Journal of the American College of Cardiology 43:11, 1940-1942
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Lothar Faber, Juergen Vogt, Johannes Heintze, Andreas Peterschroeder, Hermann Esdorn, Hans Meyer, Dieter Horstkotte. (2004) Pulmonary vein stenosis after radiofrequency pulmonary vein isolation for atrial fibrillation. Journal of the American Society of Echocardiography 17:5, 491-492
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CHRISTOPH SCHARF, HAKAN ORAL, AMAN CHUGH, BURR HALL, ERIC GOOD, PETER CHEUNG, FRANK PELOSI, FRED MORADY. (2004) Acute Effects of Left Atrial Radiofrequency Ablation on Atrial Fibrillation. Journal of Cardiovascular Electrophysiology 15:5, 515-521
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Anthony R. Magnano, Ian Woollett, Hasan Garan. (2004) Percutaneous Catheter Ablation Procedures for the Treatment of Atrial Fibrillation. Journal of Cardiac Surgery 19:3, 188-195
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DAVID SCHWARTZMAN, RAVEEN BAZAZ, JOHN NOSBISCH. (2004) Common Left Pulmonary Vein:. Journal of Cardiovascular Electrophysiology 15:5, 560-566
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Thanos Athanasiou, Omer Aziz, Omar Mangoush, Arjuna Weerasinghe, Sharif Al-Ruzzeh, Sanjay Purkayastha, John Pepper, Mohamed Amrani, Brian Glenville, Roberto Casula. (2004) Do off-pump techniques reduce the incidence of postoperative atrial fibrillation in elderly patients undergoing coronary artery bypass grafting?. The Annals of Thoracic Surgery 77:5, 1567-1574
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YAO-CHANG CHEN, SHIH-ANN CHEN, YI-JEN CHEN, CHING-TAI TAI, PAUL CHAN, CHENG-I LIN. (2004) T-Type Calcium Current in Electrical Activity of Cardiomyocytes Isolated from Rabbit Pulmonary Vein. Journal of Cardiovascular Electrophysiology 15:5, 567-571
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MOUSSA MANSOUR. (2004) Learning While Burning:. Journal of Cardiovascular Electrophysiology 15:5, 522-523
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MOUSSA MANSOUR, JEREMY RUSKIN, DAVID KEANE. (2004) Efficacy and Safety of Segmental Ostial Versus Circumferential Extra-Ostial Pulmonary Vein Isolation for Atrial Fibrillation. Journal of Cardiovascular Electrophysiology 15:5, 532-537
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Tsu-Juey Wu, Walter F Kerwin, Chun Hwang, C.Thomas Peter, Peng-Sheng Chen. (2004) Atrial fibrillation: focal activity, re-entry, or both?. Heart Rhythm 1:1, 117-120
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KOJI MIYAMOTO, KOJIRO NAKAO, SHINJI SETO, RIYAKO SHIBATA, YOSHIYUKI DOI, SATOKI FUKAE, KIYOTAKA MATSUO, NORIHIRO KOMIYA, KATSUSUKE YANO. (2004) Abnormal Right Atrial Electrograms Predict the Transition to Chronic Atrial Fibrillation in Paced Patients with Sick Sinus Syndrome. Pacing and Clinical Electrophysiology 27:5, 644-650
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Yaariv Khaykin, Nassir F Marrouche, Walid Saliba, Robert Schweikert, Dianna Bash, Michael S Chen, Michelle Williams-Andrews, Eduardo Saad, David J Burkhardt, Mandeep Bhargava, George Joseph, Antonio Rossillo, Demet Erciyes, David Martin, Andrea Natale. (2004) Pulmonary vein antrum isolation for treatment of atrial fibrillation in patients with valvular heart disease or prior open heart surgery. Heart Rhythm 1:1, 33-39
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Joao Q. Melo, Teresa Santiago, Rosa H. Gouveia, Ana P. Martins. (2004) Atrial Ablation for the Surgical Treatment of Atrial Fibrillation:. Principles and Limitations. Journal of Cardiac Surgery 19:3, 207-210
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LARS LICKFETT, RITSUSHI KATO, HARIKRISHNA TANDRI, VINOD JAYAM, CHANDRASEKHAR R. VASAMREDDY, TIMM DICKFELD, THORSTEN LEWALTER, BERNDT LUDERITZ, RONALD BERGER, HENRY HALPERIN, HUGH CALKINS. (2004) Characterization of a New Pulmonary Vein Variant Using Magnetic Resonance Angiography:. Journal of Cardiovascular Electrophysiology 15:5, 538-543
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Douglas P Zipes. (2004) The year in electrophysiology. Journal of the American College of Cardiology 43:7, 1306-1314
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A. Marc Gillinov, Patrick M. McCarthy, Eugene H. Blackstone, Gosta Pettersson, Royce Calhoun, Joseph F. Sabik, Delos M. Cosgrove III. (2004) Bipolar Radiofrequency to Ablate Atrial Fibrillation in Patients Undergoing Mitral Valve Surgery. The Heart Surgery Forum 7:2, 63-68
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THOMAS J. JENSEN, JENS HAARBO, STEEN M. PEHRSON, BLOCH THOMSEN. (2004) Impact of Premature Atrial Contractions in Atrial Fibrillation. Pacing and Clinical Electrophysiology 27:4, 447-452
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Andreas Goette, Uwe Lendeckel. (2004) Nonchannel drug targets in atrial fibrillation. Pharmacology & Therapeutics 102:1, 17-36
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HAKAN ORAL, AMAN CHUGH, CHRISTOPH SCHARF, BURR HALL, PETER CHEUNG, SRIKAR VEERAREDDY, ERIC GOOD, FRANK PELOSI JR., FRED MORADY. (2004) Incremental Value of Isolating the Right Inferior Pulmonary Vein During Pulmonary Vein Isolation Procedures in Patients With Paroxysmal Atrial Fibrillation. Pacing and Clinical Electrophysiology 27:4, 480-484
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JIAN PENG, ANTONIO H. MADRID, ALBERTO PALMEIRO, JOSE MARIA G REBOLLO, LILIANNA LIMON, SEBASTIAN NANNINI, IRENE MARIN, ENRIQUE BERNAL, CARLOS ESCOBAR, MARIA VIANA, CONCEPCION MORO. (2004) Saline Irrigated Catheter Ablation for Pulmonary Vein Isolation in Pigs:. An Experimental Model. Pacing and Clinical Electrophysiology 27:4, 495-501
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Ara A Vaporciyan, Arlene M Correa, David C Rice, Jack A Roth, W.R Smythe, Stephen G Swisher, Garrett L Walsh, Joe B Putnam. (2004) Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients. The Journal of Thoracic and Cardiovascular Surgery 127:3, 779-786
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JAMES A. ROTH. (2004) Atrial Fibrillation and the Graying of America. Pacing and Clinical Electrophysiology 27:3, 285-286
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Takashi Nitta, Yosuke Ishii, Yasuo Miyagi, Hiroya Ohmori, Shun-ichiro Sakamoto, Shigeo Tanaka. (2004) Concurrent multiple left atrial focal activations with fibrillatory conduction and right atrial focal or reentrant activation as the mechanism in atrial fibrillation. The Journal of Thoracic and Cardiovascular Surgery 127:3, 770-778
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Richard B Schuessler. (2004) Do we need a map to get through the maze?. The Journal of Thoracic and Cardiovascular Surgery 127:3, 627-628
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Michael S Chen, Nassir F Marrouche, Yaariv Khaykin, A.Marc Gillinov, Oussama Wazni, David O Martin, Antonio Rossillo, Atul Verma, Jennifer Cummings, Demet Erciyes, Eduardo Saad, Mandeep Bhargava, Dianna Bash, Robert Schweikert, David Burkhardt, Michelle Williams-Andrews, Alejandro Perez-Lugones, Ahmad Abdul-Karim, Walid Saliba, Andrea Natale. (2004) Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function. Journal of the American College of Cardiology 43:6, 1004-1009
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MONIQUE R.M. JONGBLOED, MARTIN J. SCHALIJ, ROBERT E. POELMANN, NICO A. BLOM, MADELON L. FEKKES, ZHIYONG WANG, GLENN I. FISHMAN, ADRIANA C. GITTENBERGER-DE GROOT. (2004) Embryonic Conduction Tissue:. Journal of Cardiovascular Electrophysiology 15:3, 349-355
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Nadir Saoudi. (2004) Pulmonary vein isolation for atrial fibrillation in low ejection fraction patients: the market is growing!. Journal of the American College of Cardiology 43:6, 1010-1012
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LING-PING LAI, JIUNN-LEE LIN, CHICH-SHENG LIN, HUEI-MING YEH, YEOU-GUANG TSAY, CHWEN-FANG LEE, HSIAO-HUI LEE, ZEE-FEN CHANG, JUEY-JEN HWANG, MING-JAI SU, YUNG-ZU TSENG, SHOEI K. STEPHEN HUANG. (2004) Functional Genomic Study on Atrial Fibrillation Using cDNA Microarray and Two-Dimensional Protein Electrophoresis Techniques and Identification of the Myosin Regulatory Light Chain Isoform Reprogramming in Atrial Fibrillation. Journal of Cardiovascular Electrophysiology 15:2, 214-223
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DAGMARA DILLING-BOER, NICO VAN DER MERWE, JOZEF ADAMS, STEFAAN FOULON, HUBERT GOETHALS, RIK WILLEMS, HUGO ECTOR, HEIN HEIDBUCHEL. (2004) Ablation of Focally Induced Atrial Fibrillation:. Selective or Extensive?. Journal of Cardiovascular Electrophysiology 15:2, 200-205
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Jack C Salerno, Naomi J Kertesz, Richard A Friedman, Arnold L Fenrich. (2004) Clinical course of atrial ectopic tachycardia is age-dependent: results and treatment in children <3 or ≥3 years of age. Journal of the American College of Cardiology 43:3, 438-444
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JAMES L. COX. (2004) Cardiac Surgery for Arrhythmias. Journal of Cardiovascular Electrophysiology 15:2, 250-262
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Sarah A McMurry, Charles W Hogue. (2004) Atrial fibrillation and cardiac surgery. Current Opinion in Anaesthesiology 17:1, 63-70
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PRAPA KANAGARATNAM, ASHOK CHERIAN, REX D.L. STANBRIDGE, BRIAN GLENVILLE, NICHOLAS J. SEVERS, NICHOLAS S. PETERS. (2004) Relationship Between Connexins and Atrial Activation During Human Atrial Fibrillation. Journal of Cardiovascular Electrophysiology 15:2, 206-216
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DAVID SCHWARTZMAN, HIDEAKI KANZAKI, RAVEEN BAZAZ, JOHN GORCSAN. (2004) Impact of Catheter Ablation on Pulmonary Vein Morphology and Mechanical Function. Journal of Cardiovascular Electrophysiology 15:2, 161-167
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AMAN CHUGH, MEHMET OZAYDIN, CHRISTOPH SCHARF, STEVE W.K. LAI, BURR HALL, PETER CHEUNG, FRANK PELOSI, BRADLEY P. KNIGHT, FRED MORADY, HAKAN ORAL. (2004) Mechanism of Immediate Recurrences of Atrial Fibrillation After Restoration of Sinus Rhythm. Pacing and Clinical Electrophysiology 27:1, 77-82
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CHANDRASEKHAR R. VASAMREDDY, VINOD JAYAM, LARS LICKFETT, KHURRAM NASIR, DAVID J. BRADLEY, ZAYD ELDADAH, TIMM DICKFELD, KEVIN DONAHUE, HENRY R. HALPERIN, RONALD BERGER, HUGH CALKINS. (2004) Technique and Results of Pulmonary Vein Angiography in Patients Undergoing Catheter Ablation of Atrial Fibrillation. Journal of Cardiovascular Electrophysiology 15:1, 21-26
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FRED MORADY. (2004) Catheter Ablation of Supraventricular Arrhythmias:. State of the Art. Pacing and Clinical Electrophysiology 27:1, 125-142
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LEONARDO CALÒ, FILIPPO LAMBERTI, MARIA LUISA LORICCHIO, ANTONIO CASTRO, SHLOMO SHPUN, AUGUSTO BOGGI, CLAUDIO PANDOZI, MASSIMO SANTINI. (2004) Long-Term Follow-Up of Right Atrial Ablation in Patients with Atrial Fibrillation:. Journal of Cardiovascular Electrophysiology 15:1, 37-43
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Naoki Isobe, Koichi Taniguchi, Shigeru Oshima, Hiroshi Kamiyama, Masahiko Ezure, Tatsuo Kaneko, Hiroshi Tada, Hitoshi Adachi, Takuji Toyama, Shigeto Naito, Hiroshi Hoshizaki. (2004) Factors Predicting Success in Cryoablation of the Pulmonary Veins in Patients With Chronic Atrial Fibrillation. Circulation Journal 68:11, 999-1003
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Bruno Chiappini, Sofia Martìn-Suàrez, Antonino LoForte, Giorgio Arpesella, Roberto Di Bartolomeo, Giuseppe Marinelli. (2004) Cox/Maze III operation versus radiofrequency ablation for the surgical treatment of atrial fibrillation: a comparative study. The Annals of Thoracic Surgery 77:1, 87-92
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VIVEK Y. REDDY, CHRISTOPHER HOUGHTALING, JAY FALLON, GWEN FISCHER, NORM FARR, JAMIE CLARKE, JON MCINTYRE, ED SINOFSKY, JEREMY N. RUSKIN, DAVID KEANE. (2004) Use of a Diode Laser Balloon Ablation Catheter to Generate Circumferential Pulmonary Venous Lesions in an Open-Thoracotomy Caprine Model. Pacing and Clinical Electrophysiology 27:1, 52-57
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Marleen E. Irwin. (2004) Cardiac Pacing Device Therapy for Atrial Dysrhythmias. AACN Clinical Issues: Advanced Practice in Acute and Critical Care 15:3, 377-390
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MANDEEP BHARGAVA, NASSIR F. MARROUCHE, DAVID O. MARTIN, ROBERT A. SCHWEIKERT, WALID SALIBA, EDUARDO B. SAAD, DIANNA BASH, MICHELLE WILLIAMS-ANDREWS, ANTONIO ROSSILLO, DEMET ERCIYES, YAARIV KHAYKIN, J. DAVID BURKHARDT, GEORGE JOSEPH, PATRICK J. TCHOU, ANDREA NATALE. (2004) Impact of Age on the Outcome of Pulmonary Vein Isolation for Atrial Fibrillation Using Circular Mapping Technique and Cooled-Tip Ablation Catheter:. Journal of Cardiovascular Electrophysiology 15:1, 8-13
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Yoshifusa AIZAWA. (2004) New Therapeutic Strategies for Atrial Fibrillation: 3. Catheter Ablation of Atrial Fibrillation: Its Indication and Problems. Internal Medicine 43:2, 164-166
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RUKSHEN WEERASOORIYA, PIERRE JAÏS, CHRISTOPHE SCAVÉE, LAURENT MACLE, DIPEN C. SHAH, THOMAS ARENTZ, JORGE A. SALERNO, FLORENCE RAYBAUD, KEE-JOON CHOI, MÉLÈZE HOCINI, JACQUES CLÉMENTY, MICHEL HAÏSSAGUERRE. (2003) Dissociated Pulmonary Vein Arrhythmia:. Journal of Cardiovascular Electrophysiology 14:11, 1173-1179
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GUILHERME FENELON, RICHARD K. SHEPARD, BRUCE S. STAMBLER. (2003) Focal Origin of Atrial Tachycardia in Dogs with Rapid Ventricular Pacing-Induced Heart Failure. Journal of Cardiovascular Electrophysiology 14:10, 1093-1102
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PAULUS KIRCHHOF, LARS ECKARDT, MICHAEL R. FRANZ, GEROLD MÖNNIG, PETER LOH, HORST WEDEKIND, ERIC SCHULZE-BAHR, GÜNTER BREITHARDT, WILHELM HAVERKAMP. (2003) Prolonged Atrial Action Potential Durations and Polymorphic Atrial Tachyarrhythmias in Patients with Long QT Syndrome. Journal of Cardiovascular Electrophysiology 14:10, 1027-1033
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Polychronis E. Dilaveris, Antonios Pantazis, George Zervopoulos, George Tzannetis, John Kallikazaros, Christodoulos Stefanadis, Pavlos K. Toutouzas. (2003) Differences in the morphology and duration between premature P waves and the preceding sinus complexes in patients with a history of paroxysmal atrial fibrillation. Clinical Cardiology 26:7, 341-347
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HIROSHI TADA, MEHMET OZAYDIN, HAKAN ORAL, BRADLEY P. KNIGHT, AMAN CHUGH, CHRISTOPH SCHARF, FRANK PELOSI, S. ADAM STRICKBERGER, FRED MORADY. (2003) Characteristics of Rapid Rhythms Recorded Within Pulmonary Veins During Atrial Fibrillation. Pacing and Clinical Electrophysiology 26:6, 1342-1347
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CHRISTIAN KNACKSTEDT, LAURENT VISSER, JURGITA PLISIENE, MARKUS ZARSE, MATTHIAS WALDMANN, KARL MISCHKE, KARL-CHRISTIAN KOCH, RAINER HOFFMANN, ANDREAS FRANKE, PETER HANRATH, PATRICK SCHAUERTE. (2003) Dilatation of the Pulmonary Veins in Atrial Fibrillation:. A Transesophageal Echocardiographic Evaluation. Pacing and Clinical Electrophysiology 26:6, 1371-1378
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Valentin Fuster, Lars E Rydén, Richard W Asinger, David S Cannom, Harry J Crijns, Robert L Frye, Jonathan L Halperin, G.Neal Kay, Werner W Klein, Samuel Lévy, Robert L McNamara, Eric N Prystowsky, L.Samuel Wann, D.George Wyse, Raymond J Gibbons, Elliott M Antman, Joseph S Alpert, David P Faxon, Valentin Fuster, Gabriel Gregoratos, Loren F Hiratzka, Alice K Jacobs, Richard O Russell, Sidney C Smith, Werner W Klein, Angeles Alonso-Garcia, Carina Blomström-Lundqvist, Guy De Backer, Marcus Flather, Jaromir Hradec, Ali Oto, Alexander Parkhomenko, Sigmund Silber, Adam Torbicki. (2001) ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. Journal of the American College of Cardiology 38:4, 1231-1265
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Krishna Khargi, Thomas Deneke, Helmut Haardt, Bernd Lemke, Peter Grewe, Klaus-Michael Müller, Axel Laczkovics. (2001) Saline-irrigated, cooled-tip radiofrequency ablation is an effective technique to perform the Maze procedure. The Annals of Thoracic Surgery 72:3, S1090-S1095
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Stephen B. Sloan, Howard H. Weitz. (2001) POSTOPERATIVE ARRHYTHMIAS AND CONDUCTION DISORDERS. Medical Clinics of North America 85:5, 1171-1189
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David J Bradley, Peter S Fischbach, Ian H Law, Gerald A Serwer, Macdonald Dick. (2001) The clinical course of multifocal atrial tachycardia in infants and children. Journal of the American College of Cardiology 38:2, 401-408
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Jayant Bagai, Boaz Avitall. (2001) Atrial fibrillation. Current Treatment Options in Cardiovascular Medicine 3:4, 261-276
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Mathew R. Williams, James R. Stewart, Steven F. Bolling, Sarah Freeman, James T. Anderson, Michael Argenziano, Craig R. Smith, Mehmet C. Oz. (2001) Surgical treatment of atrial fibrillation using radiofrequency energy. The Annals of Thoracic Surgery 71:6, 1939-1944
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Boaz Avitall, Arvydas Urbonas, Scott Millard, Dalia Urboniene, Ray Helms. (2001) Ablation of atrial fibrillation in the rapid pacing canine model using a multi-electrode loop catheter. Journal of the American College of Cardiology 37:6, 1733-1740
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Tse-Min Lu, Ching-Tai Tai, Ming-Hsiung Hsieh, Chin-Feng Tsai, Yung-Kuo Lin, Wen-Chung Yu, Hsuan-Ming Tsao, Shih-Huang Lee, Yu-An Ding, Mau-Song Chang, Shih-Ann Chen. (2001) Electrophysiologic characteristics in initiation of paroxysmal atrial fibrillation from a focal area. Journal of the American College of Cardiology 37:6, 1658-1664
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Ching-Tai Tai, Shih-Ann Chen, Jyh-Woei Tzeng, Benjamin I Kuo, Yu-An Ding, Mau-Song Chang, Liang-Yu Shyu. (2001) Prolonged fractionation of paced right atrial electrograms in patients with atrial flutter and fibrillation. Journal of the American College of Cardiology 37:6, 1651-1657
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Piamsook Angkeow, Hugh G. Calkins. (2001) Complications Associated with Radiofrequency Catheter Ablation of Cardiac Arrhythmias. Cardiology in Review 9:3, 121-130
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Taijiro Sueda, Katsuhiko Imai, Osamu Ishii, Kazumasa Orihashi, Masanobu Watari, Kenji Okada. (2001) Efficacy of pulmonary vein isolation for the elimination of chronic atrial fibrillation in cardiac valvular surgery. The Annals of Thoracic Surgery 71:4, 1189-1193
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Jiunn-Lee Lin, Ling-Ping Lai, Yung-Zu Tseng, Wen-Pin Lien, Shoei K.Stephen Huang. (2001) Global distribution of atrial ectopic foci triggering recurrence of atrial tachyarrhythmia after electrical cardioversion of long-standing atrial fibrillation: a bi-atrial basket mapping study. Journal of the American College of Cardiology 37:3, 904-910
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Rosemary S. Bubien, Javier E. Sanchez. (2001) Atrial Fibrillation: Treatment Rationale and Clinical Utility of Nonpharmacologic Therapies. AACN Clinical Issues: Advanced Practice in Acute & Critical Care 12:1, 140-155
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Taijiro Sueda, Katsuhiko Imai, Kazumasa Orihashi, Masanobu Watari, Kenji Okada. (2001) Pulmonary vein orifice isolation for elimination of chronic atrial fibrillation. The Annals of Thoracic Surgery 71:2, 708-710
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Fiorenzo Gaita, Leonardo Calò, Riccardo Riccardi, Lucia Garberoglio, Marco Scaglione, Giovanni Licciardello, Luisella Coda, Paolo Di Donna, Mario Bocchiardo, Domenico Caponi, Renzo Antolini, Fulvio Orzan, GianPaolo Trevi. (2001) Different patterns of atrial activation in idiopathic atrial fibrillation: simultaneous multisite atrial mapping in patients with paroxysmal and chronic atrial fibrillation. Journal of the American College of Cardiology 37:2, 534-541
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Koichiro Kumagai, Hideaki Tojo, Hiroo Noguchi, Tomoo Yasuda, Hideki Tamari, Naomichi Matsumoto, Naoki Gondo, Hideko Nakashima, Keijiro Saku. (2001) Effects of Cavotricuspid Isthmus Catheter Ablation on Paroxysmal Atrial Fibrillation.. Japanese Heart Journal 42:1, 79-89
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Kuan-Cheng Chang, Yu-Chin Lin, Jan-Yow Chen, Hsiang-Tai Chou, Jui-Sung Hung. (2001) Electrophysiological Characteristics and Radiofrequency Ablation of Focal Atrial Tachycardia Originating From the Superior Vena Cava. Japanese Circulation Journal 65:12, 1034-1040
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Ming Yang, Haydar Akbari, Gautham P. Reddy, Charles B. Higgins. (2001) Identification of Pulmonary Vein Stenosis After Radiofrequency Ablation for Atrial Fibrillation Using MRI. Journal of Computer Assisted Tomography 25:1, 34-35
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Nathaniel M. Fried, Arkadiy Tsitlik, Kenneth C. Rent, Ronald D. Berger, Albert C. Lardo, Hugh Calkins, Henry R. Halperin. (2001) Laser ablation of the pulmonary veins by using a fiberoptic balloon catheter: Implications for treatment of paroxysmal atrial fibrillation. Lasers in Surgery and Medicine 28:3, 197-203
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Claudio Pandozi, Leopoldo Bianconi, Leonardo Calò, Antonio Castro, Filippo Lamberti, Maria Carmela Scianaro, Giuseppe Gentilucci, Massimo Santini. (2000) Postcardioversion atrial electrophysiologic changes induced by oral verapamil in patients with persistent atrial fibrillation. Journal of the American College of Cardiology 36:7, 2234-2241
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Richard G. Trohman, Joseph E. Parrillo. (2000) Direct current cardioversion: Indications, techniques, and recent advances. Critical Care Medicine 28:Supplement, N170-N173
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Dave T Kim, Angela C Lai, Chun Hwang, Ling-Tao Fan, Hyrar S Karagueuzian, Peng-Sheng Chen, Michael C Fishbein. (2000) The ligament of Marshall: a structural analysis in human hearts with implications for atrial arrhythmias. Journal of the American College of Cardiology 36:4, 1324-1327
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Mina K. Chung. (2000) Cardiac surgery: Postoperative arrhythmias. Critical Care Medicine 28:Supplement, N136-N144
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J. MICHAEL MANGRUM, DAVID E. HAINES, JOHN P. DIMARCO, J. PAUL MOUNSEY. (2000) Elimination of Focal Atrial Fibrillation with a Single Radiofrequency Ablation: Use of a Basket Catheter in a Pulmonary Vein for Computerized Activation Sequence Mapping. Journal of Cardiovascular Electrophysiology 11:10, 1159-1164
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ANTON E. TUINENBURG, ISABELLE C. GELDER, ROBERT G. TIELEMAN, JAN G. GRANDJEAN, ROLE C.G. HUET, JOOST M.A.A. MAATEN, ELS G. PIEPER, PIETER J. KAM, TJARK EBELS, HARRY J.G.M. CRIJNS. (2000) Mini-Maze Suffices as Adjunct to Mitral Valve Surgery in Patients with Preoperative Atrial Fibrillation. Journal of Cardiovascular Electrophysiology 11:9, 960-967
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MING-HSIUNG HSIEH, CHING-TAI TAI, CHIN-FENG TSAI, WEN-CHUNG YU, SHIH-HUANG LEE, YUNG-KUO LIN, YU-AN DING, MAU-SONG CHANG, SHIH-ANN CHEN. (2000) Pulmonary Vein Electrogram Characteristics in Patients with Focal Sources of Paroxysmal Atrial Fibrillation. Journal of Cardiovascular Electrophysiology 11:9, 953-959
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Ching-Tai Tai, Chuen-Wang Chiou, Zu-Chi Wen, Ming-Hsiung Hsieh, Chin-Feng Tsai, Wei-Shiang Lin, Chien-Cheng Chen, Yung-Kuo Lin, Wen-Chung Yu, Yu-An Ding, Mau-Song Chang, Shin-Ann Chen. (2000) Effect of phenylephrine on focal atrial fibrillation originating in the pulmonary veins and superior vena cava. Journal of the American College of Cardiology 36:3, 788-793
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Koichiro Kumagai, Kikuya Uno, Celeen Khrestian, Albert L. Waldo. (2000) Single site radiofrequency catheter ablation of atrial fibrillation: studies guided by simultaneous multisite mapping in the canine sterile pericarditis model. Journal of the American College of Cardiology 36:3, 917-923
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DAVID SCHWARTZMAN. (2000) Premature Depolarization Concealed in Two Pulmonary Veins. Journal of Cardiovascular Electrophysiology 11:8, 931-934
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Bradley P. Knight, Fred Morady. (2000) Supraventricular tachyarrhythmia. Current Treatment Options in Cardiovascular Medicine 2:4, 297-308
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Roger A. Marinchak, Peter R. Kowey, Seth J. Rials, David Bharucha. (2000) Atrial fibrillation. Current Treatment Options in Cardiovascular Medicine 2:4, 281-295
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PIERRE JAÏS, DIPEN C. SHAH, MÉLÈZE HOCINI, TEIICHI YAMANE, MICHEL HAÏSSAGUERRE, JACQUES CLÉMENTY. (2000) Radiofrequency Catheter Ablation for Atrial Fibrillation. Journal of Cardiovascular Electrophysiology 11:7, 758-761
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SHIH-HUANG LEE, CHING-TAI TAI, WEI-SHIANG UN, CHIN-FENG TSAI, MING-HSIUNG HSIEH, WEN-CHUNG YU, YUNG-KUO LIR, CHIEN-CHENG CHEN, YU-AN DING, MAU-SONG CHANG, SHIH-ANN CHEN. (2000) Predicting the Arrhythmogenic Foci of Atrial Fibrillation Before Atrial Transseptal Procedure:.. Journal of Cardiovascular Electrophysiology 11:7, 750-757
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Fiorenzo Gaita, Roberto Gallotti, Leonardo Calò, Eric Manasse, Riccardo Riccardi, Lucia Garberoglio, Francesco Nicolini, Marco Scaglione, Paolo Di Donna, Domenico Caponi, Giorgio Franciosi. (2000) Limited posterior left atrial cryoablation in patients with chronic atrial fibrillation undergoing valvular heart surgery. Journal of the American College of Cardiology 36:1, 159-166
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Shih-Ann Chen, Ching-Tai Tai, Ming-Hsiung Hsieh, Chin-Feng Tsai, Yung-Kuo Lin, Yu-An Ding, Mau-Song Chang. (2000) Radiofrequency catheter ablation of atrial fibrillation initiated by spontaneous ectopic beats. Current Cardiology Reports 2:4, 322-328
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Eimei Shimoike, Yoshikazu Kaji, Norihiro Ueda, Toru Maruyama, Shozo Kanaya, Yoshiyuki Niho. (2000) In vivo and in vitro study of radio-frequency application with a new long linear probe. The Journal of Thoracic and Cardiovascular Surgery 120:1, 164-172
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NADIR SAOUDI. (2000) Atrial Fibrillation and the Subatrial Location of the Atrioventricular Nodal Reentrant Circuit:.. Journal of Cardiovascular Electrophysiology 11:7, 816-818
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PAULUS KIRCHHOF, LARS ECKARDT, GEROLD MÖNNIG, ROBERT JOHNA, PETER LOH, ERIC SCHULZE-BAHR, GÜNTER BREITHARDT, MARTIN BORGGREEE, WILHELM HAVERKAMP. (2000) A Patient with "Atrial Torsades de Pointes". Journal of Cardiovascular Electrophysiology 11:7, 806-811
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SABINE ERNST, FEIFAN OUYANG, BIRKE SCHNEIDER, KARL-HEINZ KUCK. (2000) Prevention of Atrial Fibrillation by Complete Compartmentalization of the Left Atrium Using a Catheter Technique. Journal of Cardiovascular Electrophysiology 11:6, 686-690
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MAURICIO I. SCANAVACCA, LUIZ J. KAJITA, MARCELO VIEIRA, EDUARDO A. SOSA. (2000) Pulmonary Vein Stenosis Complicating Catheter Ablation of Focal Atrial Fibrillation. Journal of Cardiovascular Electrophysiology 11:6, 677-681
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PIERRE JAÏS, JING TIAN PENG, DIPEN C. SHAH, STÉPHANE GARRFGUE, MÉLÈZE HOCINI, TEIICHI YAMANE, MICHEL HAISSAGUERRE, SERGE S. BAROLD, RAYMOND ROUDAUT, JACQUES CLEMENTY. (2000) Left Ventricular Diastolic Dysfunction in Patients with So-Called Lone Atrial Fibrillation. Journal of Cardiovascular Electrophysiology 11:6, 623-625
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