Li, Xuping

Liu, Qiming

Liu, Zhenjiang

Xiao, Yichao

Zhou, Shenghua

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J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 6 6 , N O . 1 6 , S U P P L S , 2 0 1 5 C185GW26-e4463
Clinical study of Circumferential pulmonary vein and 2C3L ablation
stragety for atrial ﬁbrillation
Yiqiang Yuan, Jing Li, Shuhong Wang, Ruimin Wang, Hua Zhang,
Yu Zhang, Li Yu, Yujie Zhao
The Seventh Hospital of Zhengzhou, Cardiovascular Hospital of
Zhengzhou
OBJECTIVES To investigate the effectiveness of circumferential pul-
monary vein (PV) ablation for paroxysmal atrial ﬁbrillation (PAF),
circumferential PV, linear lesions on roof of left atrium, mitral isthmus
and tricuspid isthmus ablation (2C3L) for permanent AF were created
under guidance of Carto system.
METHODS 351 patients in our hospital during the period from June
2010 to Oct 2012 with AF (282 paroxysmal AF and 69 permanent
AF) underwent circumferential pulmonary vein ablation under
guidance of the Carto system. Left atrial maps were reconstructed
with Carto system. Radiofrequency ablation was performed to
create circumferential lines around each PV, complete PVs electric
isolation was conﬁrmed by lasso catheter. If AF persisted, linear
lesions on roof of left atrium, mitral isthmus and tricuspid isthmus
were created. Finally direct current cardioversion were given if si-
nus rhythm did not return, and pulmonary vein isolation ablation
verify and three linear ablation lines bidirectional conduction block
in sinus rhythm.
RESULTS All 351 patients were successfully performed with circum-
ferential pulmonary vein ablation. Among them 221 patients were
performed circumferential pulmonary vein ablation. Another 130 pa-
tients were also performed linear lesions on roof of left atrium, mitral
isthmus and tricuspid isthmus. During 3w24months’ follow up,
28patients recurred with AF, another 15 patients recurred with atrial
tachycardia. The success rate was 87.5% in the study.
CONCLUSIONS Carto system under the guidance of circumferential
PV ablation treatment of paroxysmal atrial ﬁbrillation, 2C3L strategy
exact effect of treatment of persistent atrial ﬁbrillation, the success
rate is high.GW26-e5416
Radiofrequency ablation of left-sided accessory pathways in patients with
mechanical mitral and aortic valve prosthesis
Yichao Xiao, Shenghua Zhou, Zhenjiang Liu, Xuping Li, Qiming Liu
Department of Cardiology, Second Xiangya Hospital, Central South
University, China
OBJECTIVES Radiofrequency (RF) catheter ablation of left-sided
accessory pathways is really a great challenge in patients with
prosthetic heart valves so that it is in general delayed or even
avoided in such patients due to concerns of the higher perceived
risks of mechanical complications and difﬁculty of catheter manip-
ulation in the presence of mechanical valves. We sought to evaluate
the safety and feasibility of radiofrequency ablation of left-sided
accessory pathways in patients with mechanical mitral and aortic
valve prosthesis.
METHODS Nine patients with conﬁrmed left side manifest accessory
pathway and mechanical mitral and aortic valve prosthesis, were
included in this single-center, retrospective, cohort study. The clin-
ical, procedural, and outcome data were analyzed.
RESULTS All nine patients received 14 times (1.6  0.7, 95% CI 0.99-
2.11) of atrial septal puncture (ASP) with mean procedure duration of
ASP 19.3  6.6 min. Three patients had successful ASP in the fora-
men ovale (FO), and six in unconventional site (three in posterior FO
and three in posterior-inferior FO). The mean duration of total
procedure and total ﬂuoroscopy is 90.7  24.9 and 15.6  3.0 min
respectively. Most of APs are located in left lateral, and only one in
the left posterior septal. One patient receiving two ASP procedures
was found pericardial tamponade ten minutes after successful
radiofrequency ablation. No other complications were found during
two years follow-up. A follow-up ECG showed no recurrence in all
patients.
CONCLUSIONS Catheter radiofrequency ablation is safe and
feasible for left-sided accessory pathways in patients with me-
chanical mitral and aortic valve prosthesis. Skilled atrial septal
puncture and intra-left-atrial catheter manipulation may alleviate
the challenges during ablation of APs in patients with prosthetic
heart valves.GW26-e3595
Methods for steadily right phrenic nerve pacing in patients with
cryoballoon ablation for atrial ﬁbrillation
Zheng Liu, Shu Zhang, Pihua Fang
Center of Cardiac Arrhythmia, Fuwai hospital, Beijing
OBJECTIVES Cryoballoon ablation to achieve pulmonary vein isola-
tion is effective for patients with atrial ﬁbrillation. Right phrenic
nerve palsy (PNP) is a common complication during the procedure.
Continuous monitoring the right phrenic nerve activity can reduced
incidence of PNP. We try to explore an effective method for sustained
right phrenic nerve pacing.
METHODS Between December 2014 to March 2015, 32 patients un-
derwent cyoballoon ablation of atrial ﬁbrillation are enrolled in the
study. The deﬂectable pacing catheter were placed in the supra vena
cava-right atrium (SVC-RA) region in a reversed letter U fashion. In the
right anterior oblique position, the SVC-RA region was longitudely
divided in to upper, medium, and lower region according to the
subclavian intervertebral space, and was horizontally separated into
posterior, free, and anterior wall. The modiﬁed Lead I was used to
record the diaphragmatic compound motor action potential (CMAP)
when pacing with 5mA output.
RESULTS The phrenic nerve can be steadily captured by the pacing
catheter in the SVC-RA region with the reversed letter U fashion. No
persistent PNP was observed in any of the 32 patients. A total of 285
sites were tested. The phrenic nerve can be captured in 175 sites
(61.4%). Pacing at the posterior (84.2%) and the free wall (80%) of the
SVC-RA region is more easily to capture the phrenic nerve than the
anterior wall (20%) with the stable pacing output of 5mA, the CMAP
was more easily recorded when pacing at the posterior and free wall
(p<0.001). the CMAP amplitude was negatively correlated with the
pacing threshold (correlation coefﬁcient¼-0.267, p¼0.005).
CONCLUSIONS The phrenic nerve can be steadily captured with
pacing catheter placed at the posterior and free wall of the SVC-RA
region with reversed letter U fashion. And pacing at site with lowest
threshold can present clear CMAP in modiﬁed lead I that can be
helpful to predict PNP during cryoablation.
GW26-e4554
The Clinical Study of Under the Guidance of The New Three - Dimensional
Mapping for Radiofrequency Ablation of Arrhythmias
Dongming Xie, Guolao Zhang, Yihong Yang, Zhanglin Yan,
Xiangzhong Liao, Xufeng Zhou, Jiayuan Ling, Jinhai Zhu, Bei Wang,
Ping Lai, Kun Xiao
The ﬁrst afﬁliated hospital of GanNan Medical collage
OBJECTIVES Explore the effective and safety of quickness arr-
hythmia radiofrequency ablation guide by the new three-dimensional
electro-anatomical mapping system
METHODS 238 cases of hospitalized patients with arrhythmia in the
second cardiovascular department were selected from March 2013 to
February 2015, Grouped into the three - dimensional mapping group
(138 cases), two- dimensional X-ray group (100 cases). Wherein three-
dimensional mapping group, paroxysmal supraventricular tachycardia
108 cases, 9 cases of atrial ﬂutter, frequent ventricular tachycardia (vt)
or ventricular premature beat 24 cases. Guidance of radiofrequency
ablation surgery under the CARTO 3 system; The Two-dimensional X-
ray group, paroxysmal supraventricular tachycardia of 86 cases, 9 cases
of atrial ﬂutter, frequent ventricular tachycardia (vt) or ventricular
premature beat 24 cases. Observing and comparing patients with
operation time, X-ray exposure time, success rate of surgery, compli-
cations and the ratio of tachycardia recurrence after six months.
RESULTS Operation time: There is no difference in operation time of
this two groups, paroxysmal supraventricular tachycardia (5816) min
VS (5420) min (P ¼0.061); Ventricular tachycardia or ventricular
premature group (5816) min VS(5420) min (P ¼ 0.055); X-ray
exposure time: 3d group signiﬁcantly reduced (0.510.07) min VS
(7.83.6) min, P <0.0001, Shorten the right side next to the road
where the group X-ray exposure time of the most signiﬁcant
[(0.40.02) min VS (20.27.1) min, P <0.0001, Dual atrioventricular
node group also signiﬁcantly reduced (1.10.3) min VS (5.51.7) min,
P <0.0001. Success rate: the 3d group all ablation successfully, Two-
dimensional group has 4 cases (2 cases on the right side of the bypass,
2 cases on the left side of the bypass) ablation is not successful,
Replacing three-dimensional electro-anatomical mapping system to
guide downward radio frequency ablation. Surgical ablation-related


GW26-e5416 Radiofrequency ablation of left-sided accessory pathways in patients with mechanical mitral and aortic valve prosthesis 

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GW26-e5416 Radiofrequency ablation of left-sided accessory pathways in patients with mechanical mitral and aortic valve prosthesis

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