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EXPERIMENTAL STUDY

Single site radiofrequency catheter ablation of atrial fibrillation: studies guided by simultaneous multisite mapping in the canine sterile pericarditis model

^a Department of Medicine, Case Western Reserve University and the University Hospitals of Cleveland, Cleveland, Ohio, USA

Manuscript received June 12, 1998; revised manuscript received February 10, 2000, accepted April 27, 2000.

Reprint requests and correspondence: Dr. Albert L. Waldo, Division of Cardiology, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, Ohio 44106-5038

OBJECTIVES

To test the hypothesis that when activation of Bachmann’s bundle (BB) is critical to the unstable reentrant circuits that maintain atrial fibrillation (AF) in the sterile pericarditis canine model, a lesion in BB would prevent induction of stable AF.

BACKGROUND

One mechanism of induced AF in this model is multiple unstable reentrant circuits, which frequently include BB as part of the reentrant pathway.

METHODS

Simultaneous multisite mapping studies during AF and after ablation of BB were performed by recording (384 to 396 electrodes) from both atria and the atrial septum during six induced AF episodes in six dogs with sterile pericarditis. Activation maps of AF (mean duration, 24 ± 28 min) during 12 consecutive 100-ms windows were analyzed.

RESULTS

During AF, multiple unstable reentrant circuits (mean, 1.2 ± 0.2 per window; range, 1 to 4) were observed, 68% involving BB. Nonactivation zones (mean duration, 57 ± 16 ms in the right atrium and 53 ± 23 ms in the left atrium) observed during AF were reactivated by a wave front most often coming from the atrial septum via BB (right atrium, 62%; left atrium, 67%). After successful radiofrequency catheter ablation of the midportion of BB, AF >5 s was not induced in all dogs. Mapping studies of transient AF (5 s) induced after ablation showed neither reentrant circuits nor wave fronts activating the right atrium via BB.

CONCLUSIONS

In this AF model, catheter ablation of BB terminates and prevents the induction of AF by preventing 1) formation of unstable reentrant circuits that involve BB, and 2) activation of the atrial-free walls after a nonactivation period.

Abbreviations and Acronyms   AF = atrial fibrillation   BB = Bachmann’s bundle

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