National survey of catheter ablation for atrial fibrillation: The Japanese catheter ablation registry of atrial fibrillation (J-CARAF)

AbstractTo assess the current status of atrial fibrillation (AF) ablation in Japan, the Japanese Heart Rhythm Society (JHRS) instituted a national registry, the Japanese Catheter Ablation Registry of AF (J-CARAF).MethodsUsing an online questionnaire, the JHRS invited electrophysiology centers in Japan to voluntarily and retrospectively register data regarding the AF ablation procedures performed in September, 2011.ResultsA total of 128 centers submitted data regarding AF ablation procedures in 932 patients (age 62.1±10.4 years; male 76.8%; paroxysmal AF 65.7%, CHADS2 score 1.0±1.0). The majority received oral anticoagulant therapy during and following the procedure (68.9% and 97.5%, respectively). Pulmonary vein isolation (PVI) was performed in 97.5% of the patients; ipsilateral encircling PVI was the preferred technique (79.7%). Three-dimensional (3D) mapping systems and irrigated-tip catheters were used in 94.8% and 87.7% of the procedures, respectively. Ablation methods other than PVI were performed in 78.8% of all the patients and 73.5% of the patients with paroxysmal AF. Acute complications were reported in 6.2% of the patients, but no early deaths were recorded.ConclusionsIpsilateral encircling PVI, using 3D mapping and irrigated-tip catheters, is the standard AF ablation method in Japan. However, adjunctive ablations were performed frequently, even in patients with paroxysmal AF

Successful Ablation of Cavotricuspid Isthmus-dependent Atrial Flutter Guided by Contact Force Vector in a Patient After a Tricuspid Valve Replacement

A 46-year-old man after a tricuspid valve replacement due to traumatic severe tricuspid regurgitation developed cavotricuspid isthmus-dependent counterclockwise atrial flutter. During a linear ablation using a contact force-sensing irrigated ablation catheter, the flutter could be terminated by a radiofrequency application within a deep pouch just below the bioprosthetic tricuspid valve

Antegrade and Retrograde Decremental Conduction Properties of an Accessory Pathway Associated with the Coronary Sinus Musculature

A 32-year-old man underwent catheter ablation of an orthodromic atrioventricular reentrant tachycardia. The sinus rhythm electrocardiogram exhibited a normal PQ interval and no delta waves, but atrial pacing produced a prolonged PQ interval and wide QRS morphology with right bundle-branch block due to antegrade accessory pathway (AP) conduction. During the tachycardia, atrial double potentials consisting of the coronary sinus musculature (CSM) and left atrial (LA) potentials were observed. Ventricular extrastimulation exhibited retrograde decremental conduction with an identical atrial activation sequence as during the tachycardia. A radiofrequency application within the posterolateral CS during ventricular pacing eliminated the CSM-LA conduction and concomitantly the ventriculoatrial conduction via the AP was abolished. In this case, the CSM was associated with the bidirectional decremental conduction properties of the AP, and the antegrade slow conduction resulted in the absence of a shortening of the PQ interval and delta waves during sinus rhythm despite the continuous presence of antegrade AP conduction

Three-dimensional electroanatomical mapping for non-pulmonary vein foci in a patient with complete situs inversus and dextrocardia

In patients with atrial fibrillation (AF) having congenital anatomical abnormalities, such as complete situs inversus and dextrocardia, pulmonary vein isolation (PVI) ablation can be performed safety using a three-dimensional electroanatomical mapping system. However, it is not clear whether a three-dimensional electroanatomical mapping system can be used to detect non-PV ectopic beats initiating AF in patients with complete situs inversus and dextrocardia. Here, we report a 21-year-old man with complete situs inversus and dextrocardia, who showed AF caused by non-PV ectopic beats. We successfully detected the origin of the triggered activity from the non-PV foci using three-dimensional electroanatomical mapping