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GRBQ381-3653G-FM[i-xxiv].qxd 2/29/08 11:42 PM Page i Aptara Inc. A Practical Approach to Catheter Ablation of Atrial Fibrillation GRBQ381-3653G-FM[i-xxiv].qxd 2/29/08 11:42 PM Page ii Aptara Inc. GRBQ381-3653G-FM[i-xxiv].qxd 2/29/08 11:42 PM Page iii Aptara Inc. A Practical Approach to Catheter Ablation of Atrial Fibrillation Editors HUGH CALKINS, MD Professor of Medicine Johns Hopkins University School of Medicine Director of the Arrhythmia Service and Clinical Electrophysiology Laboratory Johns Hopkins Hospital Baltimore, Maryland PIERRE JAÏS, MD Professor Department of Cardiology Université Victor Segalen–Bordeaux 2 Hôpital Cardiologique du Haut Lévèque Cardiology Department Bordeaux, France JONATHAN S. STEINBERG, MD Chief, Division of Cardiology Endowed Director, Al-Sabah Arrhythmia Institute St. Luke's and Roosevelt Hospitals New York, New York Director, Electrophysiology Valley Hospital Ridgewood, New Jersey Professor of Medicine Columbia University College of Physicians & Surgeons New York, New York GRBQ381-3653G-FM[i-xxiv].qxd 2/29/08 11:42 PM Page iv Aptara Inc. Acquisitions Editor: Frances R. DeStefano Managing Editor: Chris Potash Marketing Manager: Kimberly Schonberger Project Manager: Bridgett Dougherty Senior Manufacturing Manager: Benjamin Rivera Creative Director: Doug Smock Compositor: Aptara Inc. © 2008 by LIPPINCOTT WILLIAMS & WILKINS All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the abovementioned copyright. Printed in the USA Library of Congress Cataloging-in-Publication Data A practical approach to catheter ablation of atrial fibrillation / editors, Hugh Calkins, Pierre Jaïs, Jonathan S. Steinberg. p. ; cm. ISBN-13: 978-0-7817-7559-5 (alk. paper) ISBN-10: 0-7817-7559-0 (alk. paper) 1. Catheter ablation. 2. Atrial fibrillation—Surgery. I. Calkins, Hugh, 1956– II. Jaïs, Pierre, 1964– III. Steinberg, Jonathan S. [DNLM: 1. Atrial Fibrillation—surgery. 2. Catheter Ablation—methods. WG 330 P8948 2008] RD598.35.C39P73 2008 617.4'120592—dc22 2008006111 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. 10 9 8 7 6 5 4 3 2 1 GRBQ381-3653G-FM[i-xxiv].qxd 2/29/08 11:42 PM Page v Aptara Inc. To Alice, Rachel, and Josh, whose encouragement and support made all this effort possible —JS To Beth, Emily, Eliza, and Daniel —HC GRBQ381-3653G-FM[i-xxiv].qxd 2/29/08 11:42 PM Page vi Aptara Inc. GRBQ381-3653G-FM[i-xxiv].qxd 2/29/08 11:42 PM Page vii Aptara Inc. CONTENTS Contributing Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii I. Introduction and Historical Perspective . . . . . . . . . . . . . . . . . . . 1 1. Indications for Atrial Fibrillation Ablation and Consensus Recommendations . . . . . . . . . . . . . . . . . . . 3 Hugh Calkins 2. Nonpharmacological Therapy for Atrial Fibrillation: An Historical Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 David A. Spragg, Hugh Calkins II. Ablation Program Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3. Equipment and Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 David Haines 4. Preprocedure Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Jose F. Huizar, Karoly Kaszala, Mark A. Wood, Kenneth A. Ellenbogen III. Mapping, Imaging, and Guidance Systems . . . . . . . . . . . . . . . 55 5. Intracardiac Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Jonathan S. Steinberg, Jayanthi Koneru, Kataneh Maleki, Farooq Chaudhry 6. Electroanatomic Mapping Systems . . . . . . . . . . . . . . . . . . 83 Anshul M. Patel, Vivek Y. Reddy 7. Magnetic and Robotic Navigation . . . . . . . . . . . . . . . . . . 100 Bruce D. Lindsay, Mitchell Faddis 8. Noncontact Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Satoshi Higa, Yenn-Jiang Lin, Ching-Tai Tai, Shih-Ann Chen vii GRBQ381-3653G-FM[i-xxiv].qxd 2/29/08 11:42 PM Page viii Aptara Inc. viii Contents IV. Ablation Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 9. Circumferential Ablation with PV Isolation Guided by Lasso Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Feifan Ouyang, Kazuhiro Satomi, Karl-Heinz Kuck 10. Circumferential Atrial Ablation . . . . . . . . . . . . . . . . . . . . 167 Carlo Pappone, Vincenzo Santinelli 11. Electrogram-Guided Ablation . . . . . . . . . . . . . . . . . . . . . . 184 Evan Lockwood, Koonlawee Nademanee 12. Linear Left Atrial Ablation . . . . . . . . . . . . . . . . . . . . . . . . . 198 Mélèze Hocini, Kang-Teng Lim, Prashanthan Sanders, Pierre Jaïs, Seiichiro Matsuo, Sébastien Knecht, Leonardo Arantès, Mark O’Neill, Yoshihide Takahashi, Jacques Clémenty, Michel Haïssaguerre 13. Tailored Approach to Ablation . . . . . . . . . . . . . . . . . . . . . 210 Hakan Oral, Fred Morady 14. Ablation of Autonomic Ganglia . . . . . . . . . . . . . . . . . . . . . 218 Hiroshi Nakagawa, Katsuaki Yokoyama, Benjamin Scherlag, Vikram Katari, Hiroshi Aoyama, Sara Foresti, Warren Jackman 15. Atrial Fibrillation Trigger Mapping . . . . . . . . . . . . . . . . . . 231 Francis Marchlinski, Fermin Garcia V. Ablation Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249 16. A Comprehensive Overview of Ablation of Paroxysmal, Persistent, and Permanent Atrial Fibrillation: A Stepwise Approach . . . . . . . . . . . . . . . . . . 251 Pierre Jaïs, Seiichiro Matsuo, Kang-Teng Lim, Mélèze Hocini, Sébastien Knecht, Leonardo Arantès, Pierre Bordachar, Jacques Clémenty, Michel Haïssaguerre 17. Emerging Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Suneet Mittal, Jonathan Steinberg, Andrew Choi, Aysha Arshad GRBQ381-3653G-FM[i-xxiv].qxd 2/29/08 11:42 PM Page ix Aptara Inc. Contents ix 18. Identification and Elimination of Ancillary Arrhythmias . . 273 Paolo Ferrero, Pietro Francia, Riccardo Cappato 19. Ablation Procedure Follow-up and Definitions of Success . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281 Christopher Piorkowski, Gerd Hindricks, Hans Kottkamp 20. When and How to Re-Ablate . . . . . . . . . . . . . . . . . . . . . . 292 Michael Riley, David Callans 21. Postprocedural Care after Radiofrequency Catheter Ablation for Atrial Fibrillation . . . . . . . . . . . . . . 310 Alan Wimmer, Hakan Oral 22. Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320 Conor Barrett, Robert Schweikert, Walid Saliba, Jennifer Cummings, J. David Burkhardt, Oussama Wazni, Andrea Natale 23. The Challenges of Monitoring Outcomes . . . . . . . . . . . . 346 Isabel Deisenhofer Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .357 GRBQ381-3653G-FM[i-xxiv].qxd 2/29/08 11:42 PM Page x Aptara Inc.