Our primary finding is that PVI performed with a wide antral approach is more effective than ostial PVI in achieving freedom from total atrial tachyarrhythmia recurrence at long-term follow-up
BACKGROUND For the past decade , electric pulmonary vein isolation ( PVI ) has become a procedure implemented worldwide for the treatment of atrial fibrillation .
Currently , 2 main approaches are used for PVI : ostial isolation of the PVs and wide antral PVI .
The aims of this systematic review are to evaluate the relative merits of each technique with a pooled comparative analysis of efficacy and complications .
Spatiotemporal periodicity during atrial fibrillation in the isolated sheep heart.
BACKGROUND The activation patterns that underlie the irregular electrical activity during atrial fibrillation ( AF ) have traditionally been described as disorganized or r and om . Recent studies , based predominantly on statistical methods , have provided evidence that AF is spatially organized . The objective of this study was to demonstrate the presence of spatial and temporal periodicity during AF . METHODS AND RESULTS We used a combination of high-resolution video imaging , ECG recordings , and spectral analysis to identify sequential wave fronts with temporal periodicity and similar spatial patterns of propagation during 20 episodes of AF in 6 Langendorff-perfused sheep hearts . Spectral analysis of AF demonstrated multiple narrow-b and peaks with a single dominant peak in all cases ( mean , 9.4+/-2.6 Hz ; cycle length , 112+/-26 ms ) . Evidence of spatiotemporal periodicity was found in 12 of 20 optical recordings of the right atrium ( RA ) and in all ( n=19 ) recordings of the left atrium ( LA ) . The cycle length of spatiotemporal periodic waves correlated with the dominant frequency of their respective optical pseudo-ECGs ( LA : R2=0.99 , slope=0.94 [ 95 % CI , 0.88 to 0.99 ] ; RA : R2=0.97 , slope=0.92 [ 95 % CI , 0.80 to 1.03 ] ) . The dominant frequency of the LA pseudo-ECG alone correlated with the global bipolar atrial EG ( R2=0.76 , slope=0.75 [ 95 % CI , 0.52 to 0.99 ] ) . In specific examples , sources of periodic activity were seen as rotors in the epicardial sheet or as periodic breakthroughs that most likely represented transmural pectinate muscle reentry . However , in the majority of cases , periodic waves were seen to enter the mapping area from the edge of the field of view . CONCLUSIONS Reentry in anatomically or functionally determined circuits forms the basis of spatiotemporal periodic activity during AF . The cycle length of sources in the LA determines the dominant peak in the frequency spectra in this experimental model of AF
Our primary finding is that PVI performed with a wide antral approach is more effective than ostial PVI in achieving freedom from total atrial tachyarrhythmia recurrence at long-term follow-up
BACKGROUND For the past decade , electric pulmonary vein isolation ( PVI ) has become a procedure implemented worldwide for the treatment of atrial fibrillation .
Currently , 2 main approaches are used for PVI : ostial isolation of the PVs and wide antral PVI .
The aims of this systematic review are to evaluate the relative merits of each technique with a pooled comparative analysis of efficacy and complications .