Author + information
- E.A. Artyukhina,
- A.S.h. Revishvili,
- V.A. Vaskovsky and
- M.V. Yashkov
In a number of cases with catheter treatment of atrial fibrillation (AF) despite the performed protocol of radiofrequency effects (isolation of pulmonary veins and linear lesions in the left atrium), sinus rhythm is not restored. In some cases radiofrequency ablation (RFA) in the right atrium leads to the restoration of the sinus rhythm in patients with paroxysmal and persistent AF. Aim: to evaluate the role and effectiveness of elimination of the right-of-ferential factor in the catheter elimination in patients with paroxysmal and persistent AF.
Retrospectively were evaluated intraoperative and remote results of 72 patients: 38 women and 4 men with a mean age of 61 ± 8.2 year, 37.5% (27) patients with the paroxysmal AF and 62.5% (45) patients with persistent AF. The duration of the arrhythmia in patients with the persistent AF was not to exceed 4 ± 2.1 months. In patients with paroxysmal AF, RFA was performed on sinus rhythm after the isolation of pulmonary veins, induction of arrhythmia was performed in all cases. Further the linear effects were performed in the left atrium, the area of the ganglionic plexus, low-amplitude fragmented activity zones. Electrophysiological diagnostics and volumetric reconstruction of the right and the left atrium were performed by «Astrocard» navigation system (Russia).
In 8.3% (7) patients, 5 with paroxysmal AF and 2 with persistent AF the zones of continuous fragmented activity are verified in the right atrium (vena cava superior-1, coronary sinus mouth - 2, the lower part of the right atrium - 3). The implementation of RFA in these areas have led to restoration of sinus rhythm. Total time of RFA was 58 ± 11 minutes, the time of RFA in the right atrium was 5 ± 3 min, at the temperature of 35±3 ° C and 42±2 W. The observation period was 6 ± 3.5 months with persistent sinus rhythm remaining.
Undoubtedly the right atrium plays an important role in maintaining of AF. Verification of continuous fragmented activity in right atrium using volumetric reconstruction allows to eliminate atrial fibrillation in patients with paroxysmal and persistent AF.