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1 Department of Medicine/Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
2 Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
3 Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA, USA
* To whom correspondence should be addressed. E-mail: chenp{at}cshs.org.
The thoracic vein hypothesis of chronic atrial fibrillation (AF) posits that rapid repetitive activations from muscle sleeves within the thoracic veins underlie the mechanism of sustained AF. If so, then thoracic vein ablation should terminate sustained AF and prevent its reinduction. Six female mongrel dogs underwent chronic pulmonary vein (PV) pacing at 20 Hz to induce sustained (>48 hours) AF. Bipolar electrodes were used to record from the atria and thoracic veins, including the Vein of Marshall (VOM), 4 pulmonary veins (PVs) and the superior vena cava (SVC). Radiofrequency (RF) application was applied around PVs, SVC and along VOM until electrical activity was eliminated. Computerized mapping (1792 electrodes, 1 mm resolution) was also performed. Sustained AF was induced in 30.6±6.5 days and ablation was done 17.3±8.5 days afterwards. Prior to ablation, the PVs had shorter activation cycle lengths than the atria, and that rapid repetitive activations were observed in the PVs. All dogs converted to sinus rhythm during (N=4) or within 90 min of completion of RF ablation. Rapid atrial pacing afterwards induced only non-sustained (<60 s) AF in all dogs. Average AF cycle lengths after re-induction were significantly (p=0.01) longer (183±31.5ms) than baseline (106±16.2ms). There were no activation cycle length gradients after RF application. We conclude that thoracic vein ablation converts canine sustained AF into sinus rhythm, and prevents the re-induction of sustained AF. These findings suggest that thoracic veins are important in the maintenance of AF in this model.
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