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Europace Advance Access published online on January 5, 2006
Europace, doi:10.1093/europace/euj013
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© The European Society of Cardiology 2006. All rights reserved
Received April 5, 2005
Accepted August 14, 2005

Article

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

Tim Risius 1 *, Thorsten Lewalter 2, Berndt Lüderitz 2, Jörg O. Schwab 2, Stefan Spitzer 3, Claus Schmitt 4, Ernst Vester 5, Thomas Rostock 1, Thomas Meinertz 1, and Stephan Willems 1

1 Department of Cardiology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
2 Department of Cardiology, University of Bonn, Bonn, Germany
3 Praxisklinik Herz und Gefässe, Dresden, Germany
4 Cardiology Department, Deutsches Herzzentrum, Munich, Germany
5 Department of Cardiology, Evangelic Hospital Duesseldorf, Germany

* To whom correspondence should be addressed.
Tim Risius, E-mail: risius{at}uke.uni-hamburg.de


  Abstract

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.

Keywords: Catheter ablation; Atrial fibrillation; ST-segment-elevation; Pulmonary vein.
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