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Europace 2005 7(5):421-427; doi:10.1016/j.eupc.2005.05.015
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© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.

Complete pulmonary vein isolation guided by three-dimensional electroanatomical mapping for the treatment of paroxysmal atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy

Xingpeng Liua, Feifan Ouyanga,*, Hercules Mavrakisa, Changsheng Mab, Jianzeng Dongb, Sabine Ernsta, Dietmar Bänscha, Matthias Antza and Karl-Heinz Kucka

aII. Med. Abteilung, Allgemeines Krankenhaus St. Georg Lohmühlenstrasse 5, 20099 Hamburg, Germany; bDepartment of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences Beijing, China

AIMS: Evaluation of the clinical outcome of patients with hypertrophic obstructive cardiomyopathy (HOCM) and paroxysmal atrial fibrillation (AF) treated with complete pulmonary vein (PV) isolation guided by three-dimensional (3-D) electroanatomical (EA) mapping.

METHODS: Circumferential radiofrequency (RF) ablation and continuous circular lesions (CCLs) around the left and right-sided PVs were performed in 4 highly symptomatic patients (2 males; age 57.5±8.3 years) with HOCM and anti-arrhythmic drug (AAD) refractory paroxysmal AF. Ablation was guided by 3-D EA mapping combined with conventional circumferential PV mapping. The endpoints of the ablation were defined as: (1) absence of all PV spikes documented with the two Lasso catheters within the ipsilateral PVs; and (2) no recurrence of the PV spikes within all PVs following intravenous administration of adenosine.

RESULTS: The ablation endpoints were achieved in all patients. A repeat ablation was performed in one patient due to repetitive atrial tachycardia, 1 month after the initial procedure. During a follow-up of 5.8±2.7 months, all patients are free of AF recurrence. Short episodes of symptomatic AT were documented after the repeat procedure, and were well controlled with oral amiodarone in the patient. No procedure-related complications were observed.

CONCLUSION: The present study demonstrates that complete isolation of ipsilateral PVs guided by 3-D EA mapping is potentially effective for the treatment of highly symptomatic, drug refractory paroxysmal AF in patients with HOCM.

Key Words: hypertrophic cardiomyopathy, atrial fibrillation, ablation, pulmonary vein

*Corresponding author. Tel.: +49 40 181885 2305; fax: +49 40 181885 4444. E-mail address: ouyangfeifan{at}aol.com (F. Ouyang).


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