Skip to main content
SpringerLink
Log in

Left atrial lesion formation and volume overload by open irrigation ablation technology during pulmonary vein antrum isolation: acute effects on cardiac hemodynamics

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Our goal was to evaluate acute effects of left atrial lesion formation and volume overload on hemodynamics during pulmonary vein antrum isolation (PVAI) as it might be a potential cause of acute pulmonary edema.

Methods

In consecutive patients presenting for PVAI, open irrigation ablation was performed (50 W, 48°C, 15 s lesion duration, saline flow rate 30 mL/min). Blood samples were drawn from the left atrium and the pulmonary artery immediately before and 30 min after PVAI. The cardiac output (CO) and stroke volume (SV) were calculated by the method of Fick.

Results

We included 61 (27 female, 61 ± 11 years) patients suffering from paroxysmal (px; 33) or persistent (per; 28) atrial fibrillation (AF) in this study. A total of 2,917 ± 242 mL of volume was infused (2,651 ± 223 mL pxAF vs. 3,184 ± 255 mL perAF, (p < 0.01)). Total ablation time was 60 ± 7 min (52 ± 7 min in pxAF vs. 69 ± 8 min in perAF; (p < 0.001)). CO increased from 5.2 ± 1.3 to 6.2 ± 1.5 L/min (p < 0.001) during PVAI (5.7 ± 1.3 to 6.5 ± 1.7 L/min in pxAF; (p < 0.002) and 4.8 ± 1.1 to 5.9 ± 1.2 L/min in perAF; (p < 0.001)). SV increased from 74 ± 24 to 83 ± 21 mL (p < 0.005) during PVAI, and subgroups showed an increase of 82 ± 23 to 88 ± 22 mL in pxAF (p < 0.009) and 62 ± 21 to 76 ± 16 mL in perAF (p < 0.009).

Conclusions

From our preliminary experience, left atrial scarring and volume overload during PVAI do not seem to impact negatively hemodynamics. On the contrary, an improvement in cardiac output was documented acutely independent of type of AF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

AF:

Atrial fibrillation

CO:

Cardiac output

LA:

Left atrium

Per:

Permanent

PV:

Pulmonary vein

PVAI:

Pulmonary vein antrum isolation

Px:

Paroxysmal

SV:

Stroke volume

References

  1. Fuster, V., Ruyden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., et al. (2006). ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation, 114, 700–752.

    Article  Google Scholar 

  2. Camm, A.J., Kirchhof, P., Lip, G.Y.H., Schotten, U., Savelieva, I., Ernst, S., et al. (2010). Guidelines for the management of atrial fibrillation. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) European Heart Journal 31, 2369–2429

  3. Verma, A., Marrouche, N. F., & Natale, A. (2004). Pulmonary vein antrum isolation: intracardiac echocardiography-guided technique. Journal of Cardiovascular Electrophysiology, 15, 1335–1340.

    Article  PubMed  Google Scholar 

  4. Haïssaguerre, M., Jais, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. The New England Journal of Medicine, 339, 659–666.

    Article  PubMed  Google Scholar 

  5. Chen, S. A., Hsieh, M. H., Tai, T. C., Tsai, C. F., Prakash, V. S., Yu, W. C., et al. (1999). Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins. Circulation, 100, 1879–1886.

    PubMed  CAS  Google Scholar 

  6. Haïssaguerre, M., Jaïs, P., Shah, D. C., Garrigue, S., Takahashi, A., Lavergne, T., et al. (2000). Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation, 101, 1409–1417.

    PubMed  Google Scholar 

  7. Haïssaguerre, M., Jaïs, P., Shah, D. C., Arentz, T., Kalusche, D., Takahashi, A., et al. (2000). Catheter ablation of chronic atrial fibrillation targeting the reinitiating triggers. Journal of Cardiovascular Electrophysiology, 11, 2–10.

    Article  PubMed  Google Scholar 

  8. Pappone, C., Rosanio, S., Oreto, G., Tocchi, M., Gugliotta, F., Vicedomini, G., et al. (2000). Circumferential radiofrequency ablation of pulmonary vein ostia: a new anatomic approach for curing atrial fibrillation. Circulation, 102, 2619–2628.

    PubMed  CAS  Google Scholar 

  9. Nademanee, K., McKenzie, J., Kosar, E., Schwab, M., Sunsaneewitayakul, B., Vasavakul, T., et al. (2004). A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. Journal of the American College of Cardiology, 43, 2044–2053.

    Article  PubMed  Google Scholar 

  10. Oral, H., Pappone, C., Chugh, A., Good, E., Bogun, F., Pelosi, F., et al. (2006). Circumferential pulmonary-vein ablation for chronic atrial fibrillation. The New England Journal of Medicine, 354, 934–939.

    Article  PubMed  CAS  Google Scholar 

  11. Yamane, T., Date, T., Kanzaki, Y., Inada, K., Matsuo, S., Shibayama, K., et al. (2007). Segmental pulmonary vein antrum isolation using the “large-size” lasso catheter in patients with atrial fibrillation. Circulation Journal, 71, 753–760.

    Article  PubMed  Google Scholar 

  12. Arentz, T., Weber, R., Bürkle, G., Herrera, C., Blum, T., Stockinger, J., et al. (2007). Small or large isolation areas around the pulmonary veins for the treatment of atrial fibrillation? Results from a prospective randomized study. Circulation, 115, 3057–3063.

    Article  PubMed  Google Scholar 

  13. Kanj, M. H., Wazni, O., Fahmy, T., Thal, S., Patel, D., Elay, C., et al. (2007). Pulmonary vein antral isolation using an open irrigation ablation catheter for the treatment of atrial fibrillation: a randomized pilot study. Journal of the American College of Cardiology, 49, 1634–1641.

    Article  PubMed  Google Scholar 

  14. McGann, C. J., Kholmovski, E. G., Oakes, R. S., Blauer, J. J., Daccarett, M., Segerson, N., et al. (2008). New magnetic resonance imaging-based method for defining the extent of left atrial wall injury after the ablation of atrial fibrillation. Journal of the American College of Cardiology, 52, 1263–1271.

    Article  PubMed  Google Scholar 

  15. Marrouche, N. F., Guenther, J., Segerson, N. M., Daccarett, M., Rittger, H., Marschang, H., et al. (2007). Randomized comparison between open irrigation technology and intracardiac-echo-guided energy delivery for pulmonary vein antrum isolation: procedural parameters, outcomes, and the effect on esophageal injury. Journal of Cardiovascular Electrophysiology, 18, 583–588.

    Article  PubMed  Google Scholar 

  16. Singh, S. M., d’Avila, A., & Reddy, V. Y. (2009). Congestive heart failure after atrial fibrillation ablation. Europace, 11, 272.

    Article  PubMed  CAS  Google Scholar 

  17. Khan, M. N., Jaïs, P., Cummings, J. E., Di Biase, L., Sanders, P., Martin, D. O., et al. (2008). Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. The New England Journal of Medicine, 359, 1778–1785.

    Article  PubMed  CAS  Google Scholar 

  18. Hsu, L. F., Jaïs, P., Sanders, P., Garrigue, S., Hocini, M., Sacher, F., et al. (2004). Catheter ablation for atrial fibrillation in congestive heart failure. The New England Journal of Medicine, 351, 2373–2383.

    Article  PubMed  CAS  Google Scholar 

  19. Krakau, I. (1999). Das Herzkatheterbuch. Diagnostische und interventionelle Herzkathetertechniken. Stuttgart: Thieme.

    Google Scholar 

  20. Warren, J. V., Staed, E. A., & Brannon, E. S. (1946). The cardiac output in man: a study of some of the errors in the method of right heart catheterization. The American Journal of Physiology, 145, 458–464.

    PubMed  CAS  Google Scholar 

  21. Morris, J. J., Entman, M., North, W. C., Kong, Y., & McIntosh, H. (1965). The changes in cardiac output with reversion of atrial fibrillation to sinus rhythm. Circulation, 31, 670–678.

    PubMed  Google Scholar 

Download references

Disclosures

Dr. Nölker received financial support for presentation of study data from Biosense Webster and Boston Scientific.

Author information

Authors and Affiliations

  1. Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany

    Georg Nölker, Klaus Jürgen Gutleben, Johannes Heintze, Bogdan Muntean, Jürgen Vogt & Dieter Horstkotte

  2. Klinikum Coburg, Coburg, Germany

    Georg Nölker, Klaus Jürgen Gutleben, Guido Ritscher, Harald Rittger, Stefan Asbach, Johannes Brachmann & Anil Martin Sinha

  3. Universitätsklinkum Freiburg, Freiburg, Germany

    Stefan Asbach

Authors
  1. Georg Nölker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Klaus Jürgen Gutleben
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guido Ritscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harald Rittger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefan Asbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Johannes Heintze
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bogdan Muntean
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jürgen Vogt
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Johannes Brachmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Dieter Horstkotte
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Anil Martin Sinha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georg Nölker.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nölker, G., Gutleben, K.J., Ritscher, G. et al. Left atrial lesion formation and volume overload by open irrigation ablation technology during pulmonary vein antrum isolation: acute effects on cardiac hemodynamics. J Interv Card Electrophysiol 31, 125–130 (2011). https://doi.org/10.1007/s10840-011-9545-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-011-9545-5

Keywords

Search

Navigation