intracardiac echocardiography-guided, anatomically based radiofrequency ablation of focal atrial fibrillation originating from pulmonary veins

Objectives In patients with a pulmonary vein (PV) source for atrial fibrillation (AF), we sought the use of intracardiac echocardiography (ICE) to evaluate PV anatomy, guide radiofrequency (RF) ablation and monitor for acute stenosis during ablation. Background A focal source for AF may be found in the proximal component of the PVs and can be effectively treated by ablative techniques. However, the procedure may be challenging due to the complex anatomy of the left atrium and PVs, uncertain catheter positioning within the PVs and difficulties in mapping atrial extrasystoles, which may be rare or repeatedly induce AF and require cardioversion. Methods Sixty-four patients were referred for RF ablation of a focal source of AF, and 56 were identified as having AF triggers in ≥1 PV. Using ICE guidance, RF lesions were applied around the circumference of the vein near the os until there was electrical isolation. Results Lesions were placed in 82 veins (36 right superior PV, 33 left superior PV, 9 left inferior PV, 4 right inferior PV); 24 ± 12 lesions per vein were necessary to create electrical isolation with a fluoroscopic time of 11 ± 4 min and a mean of 22% reduction in luminal area. After a follow-up of 13 ± 7 months, 66% of patients remained free of AF, and another 13% responded better to medications. Conclusions We describe an anatomic approach to PV electrical isolation in which ICE is used to define the anatomy, guide RF ablation and monitor for acute PV changes.