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Europace Advance Access originally published online on January 5, 2006
Europace 2006 8(3):178-181; doi:10.1093/europace/euj013
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

ELECTROPHYSIOLOGY

Transient ST-segment-elevation during pulmonary vein ablation using circumferential coiled microelectrodes in a prospective multi-centre study{dagger}

Tim Risius1,*, Thorsten Lewalter2, Berndt Lüderitz2, Jörg O. Schwab2, Stefan Spitzer3, Claus Schmitt4, Ernst Vester5, Thomas Rostock1, Thomas Meinertz1 and Stephan Willems1

1 Department of CardiologyUniversity Hospital Hamburg-EppendorfMartinistr. 52, 20246 Hamburg Germany ; 2 Department of CardiologyUniversity of BonnBonn Germany ; 3 Praxisklinik Herz und GefässeDresden Germany ; 4 Cardiology DepartmentDeutsches HerzzentrumMunich Germany ; 5 Department of CardiologyEvangelic Hospital Duesseldorf Germany

Aims Paroxysmal atrial fibrillation (PAF) is predominantly triggered by focal ectopies located within the pulmonary veins (PV). The BITMAP Study (Breakthrough and Isolation Trial: Mapping and Ablation of Pulmonary Veins) investigated prospectively the safety and efficacy of a catheter design with circumferential mapping and ablation electrodes. We report the phenomenon of ST-segment-elevation during catheter placement in the left atrium (LA) and superior PVs in this multi-centre study.

Methods and results Forty-three patients (57±10 years) with PAF were included in this study. Radiofrequency catheter (RFC) ablation supported by the 4F REVELATION Helix microcatheter (Cardima Inc., Freemont, CA, USA) with eight distal-coiled microelectrodes for bipolar mapping and ablation. RFC was applied at the ostial region of PV (30 W, 45–50°C) with a maximum of four RFC applications per electrode. In four of the 43 patients from three centres, we recorded the occurrence of ST-segment-elevation greater than 0.2 mV and accompanying left thoracic discomfort. The ECG changes and the symptoms started abruptly and lasted for 4.2±2.2 min. Pericardial effusion could instantaneously be excluded by echocardiography in all cases. Coronary angiograms were performed in three patients with the longest episodes; no thrombotic material or air emboli were present. The symptoms and the ECG changes resolved completely in all patients.

Conclusion The phenomenon of ST-segment-elevation during LA- and PV-mapping in patients with PAF may be a common occurrence. In this prospective multi-centre trial, we demonstrated the reversibility of this phenomenon; no cardiovascular or cerebral damage was reported during both the procedure and the follow-up. Although the mechanism is still unclear, vasospasm may contribute to this phenomenon because of autonomic dysregulation.

Key Words: Catheter ablation, Atrial fibrillation, ST-segment-elevation, Pulmonary vein

* Corresponding author. Tel: +49 40 42803 4120; fax: +49 40 42803 4125. E-mail address: risius{at}uke.uni-hamburg.de


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