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A Focal Source of Atrial Fibrillation Treated by Discrete Radiofrequency Ablation
Abstract
Background Atrial fibrillation is usually thought to be due to multiple circulating reentrant wavelets. From previous studies, a focal mechanism is considered to be very unlikely. In this report, focal atrial fibrillation is defined on an ECG pattern of atrial fibrillation and later demonstrated to be due to a focal source. Methods and Results Nine patients (five men and four women; age, 38±7 years) with paroxysmal focal atrial fibrillation are reported here. All were free of structural heart disease and had frequent episodes of atrial fibrillation despite the use of a mean of 4±2 antiarrhythmic drugs. Atrial fibrillation was associated with runs of irregular atrial tachycardia or monomorphic extrasystoles. The electrophysiological study demonstrated that all the atrial arrhythmias were due to the same focus firing irregularly and exhibiting a consistent and centrifugal pattern of activation. Three foci were found to be located in the right atrium, two near the sinus node and one in the ostium of the coronary sinus. Six others were located in the left atrium at the ostium of the right pulmonary veins (n=5) and at the ostium of the left superior pulmonary vein (n=1). All atrial arrhythmias were successfully treated by use of a mean of 4±4 radiofrequency pulses. Conclusions In some patients, the surface ECG pattern of atrial fibrillation is due to a focal rapidly firing source of activity that can be eliminated by discrete radiofrequency energy applications.
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Cited by
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.022 · Cited by 2,955
Cappato, R., Calkins, H., Chen, S.-A., Davies, W., Iesaka, Y., Kalman, J., Kim, Y.-H., Klein, G., Natale, A., Packer, D., et al. (2010) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.109.859116 · Cited by 2,852
Fuster, V., Rydén, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.177292 · Cited by 2,805
Calkins, H., Hindricks, G., Cappato, R., Kim, Y.-H., Saad, E. B., Aguinaga, L., Akar, J. G., Badhwar, V., Brugada, J., Camm, J., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.05.012 · Cited by 2,755
Self-citationCalkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S.-A., Crijns, H. J. G., Damiano, R. J., Davies, D. W., DiMarco, J., et al. (2012) · Europace · doi:10.1093/europace/eus027 · Cited by 2,722
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Metadata
- Authors
- Jai¨s, P., Hai¨ssaguerre, M., Shah, D. C., Chouairi, S., Gencel, L., Hocini, M., & Cle´menty, J.
- Venue
- Circulation
- Published
- 1997-02-04
- Volume
- 95
- Issue
- 3
- Pages
- 572-576
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2042898056
- Cited by
- 1,117
- References
- 0
- FWCI
- 46.96
- Type
- journal article
- Language
- en
- Open access
- closed
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- Jai¨s, P., Hai¨ssaguerre, M., Shah, D. C., Chouairi, S., Gencel, L., Hocini, M., & Cle´menty, J. (1997). A Focal Source of Atrial Fibrillation Treated by Discrete Radiofrequency Ablation. Circulation. https://doi.org/10.1161/01.cir.95.3.572
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