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We present the case of a patient who developed regular, narrow QRS tachycardia after ablation for long-standing persistent atrial fibrillation. During the electrophysiological study, this tachycardia was diagnosed as macroreentrant atrial tachycardia circulating around the mitral annulus. Catheter ablation was performed to treat the tachycardia by targeting the linear region between the annulus and the left inferior pulmonary vein. Although linear radiofrequency application along the mitral isthmus (MI) line resulted in the termination of this tachycardia, a unidirectional conduction block was observed through the MI. Bidirectional conduction block was subsequently achieved by delivering supplemental radiofrequency energies at the gap on the MI.

The case of a patient with narrow QRS tachycardia is herein presented. During an electrophysiological study, this tachycardia was diagnosed as a focal atrial tachycardia with a high sensitivity to adenosine-5′-triphosphate (2 mg), and originating from near the His-bundle region. We could not ablate the earliest activation site in the right atrium because of the simultaneous recording of the His potential. The radiofrequency applications in the right atrium around the earliest activation site failed to terminate the tachycardia. Subsequent attempt of radiofrequency application in the non-coronary aortic cusp, where the earliest atrial activation without His potential was obtained, successfully eliminated the tachycardia without any atrioventricular nodal injury.

Background: It is sometimes difficult to differentiate the transient appearance of atrial fibrillation (AF) after pulmonary vein (PV) isolation from a true recurrence of AF. We attempted to differentiate them by analyzing the time course after the procedure. Methods and Results: 79 patients who underwent PV isolation were divided into two groups (successful: N = 60 and unsuccessful: N = 19) according to the final outcome. Antiarrhythmic drugs were used either temporarily or continuously to treat re-appearance of AF after the procedure. The transient appearance of AF in the successful group gradually faded, while true AF recurrence in the unsuccessful group consistently increased in line with the follow-up (F/U) period. The appearance of AF after 3 months predicted a subsequent failure of the procedure with a positive/negative predictive value of 87/90%, respectively. Conclusion: Since the transient appearance of AF decreased and the true recurrence of AF increased in line with the F/U period, we should therefore wait at least 3 months before judging the outcome of PV isolation.

Herein we report a case of a patient presenting with paroxysmal atrial fibrillation (PAF) in whom the pulmonary veins (PVs) had a common inferior trunk and PV isolation at the common inferior trunk was successfully performed to prevent recurrence of PAR A 58-year-old man with drug-resistant PAF was referred to undergo curative treatment at our institution. A three-dimensional image of the PVs re-constructed by contrast-enhanced multi-detector computed tomography before the operation revealed a common inferior trunk of the PVs (24mm diameter). Segmental ostial PV isolation with the guidance of a circular mapping catheter was performed for both superior PVs and the common inferior PV trunk. All three PV ostia were successfully isolated from the LA, and the patient has been free from PAF thereafter for 18 months. Preprocedural multi-detector computed tomography or magnetic resonance imaging to evaluate the anatomy of PVs (the number, size, and shape) is thus considered to be useful for performing safe and smooth catheter ablation in patients with PAR

Background: Although the efficacy of pulmonary vein (PV) isolation for paroxysmal atrial fibrillation (AF) has been well-established, its effect on persistent AF has not been sufficiently established to date. Methods and Results: In 68 consecutive patients (mean age, 52 ± 10 years) with paroxysmal (45) and persistent (23) AF, isolation of all four PVs was performed and the subsequent clinical outcome was evaluated. In total, 268/272 PVs (99%) were completely isolated from the left atrium by radiofrequency applications. During a mean follow-up period of 11 months, 84% of patients with paroxysmal AF and 57% of patients with persistent AF were free from symptomatic AF without any antiarrhythmic drug (AAD) therapy (p = 0.04). In the remaining recurrent AF patients, no significant difference between the paroxysmal and persistent AF was observed as long as they took AADs which had been ineffective at baseline (freedom from AF; 98% and 96%, respectively, p = NS). Repeat procedure performed in the 12 recurrent patients (paroxysmal AF 6, persistent AF 6) allowed 11 (92%) of them to become free from AF recurrence without AADs. Conclusion: Electrical isolation of PV by standard catheter technique is equally and highly effective for both paroxysmal and persistent AF patients, when all four PVs were isolated.