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Conducting Randomized Trials in the Electrophysiology Laboratory: Lessons from a Randomized Comparison of Recording Methods During Pulmonary Vein Isolation by Segmental Ostial Ablation

dc.contributor.authorOral, Hakanen_US
dc.contributor.authorMorady, Freden_US
dc.date.accessioned2006-09-11T15:08:28Z
dc.date.available2006-09-11T15:08:28Z
dc.date.issued2003-09en_US
dc.identifier.citationOral, Hakan; Morady, Fred; (2003). "Conducting Randomized Trials in the Electrophysiology Laboratory: Lessons from a Randomized Comparison of Recording Methods During Pulmonary Vein Isolation by Segmental Ostial Ablation." Cardiac Electrophysiology Review 7(3): 247-251. <http://hdl.handle.net/2027.42/44683>en_US
dc.identifier.issn1385-2264en_US
dc.identifier.issn1573-725Xen_US
dc.identifier.urihttps://hdl.handle.net/2027.42/44683
dc.identifier.urihttp://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=14739723&dopt=citationen_US
dc.description.abstractAccurate identification of pulmonary vein (PV) potentials during segmental ostial ablation for PV isolation is very important to completely isolate the PVs and also to avoid unnecessary applications of radiofrequency energy. A prior post hoc analysis of unipolar and bipolar electrograms recorded from successful and unsuccessful ablation sites demonstrated that unipolar electrograms recorded at successful sites were more likely to have a rapid intrinsic deflection, larger amplitude, and earlier activation than electrograms recorded at unsuccessful sites. Moreover, unipolar electrograms recorded from the ablation and circular ostial mapping catheters were almost identical at successful sites. Based on these observations, a prospective, randomized study was conducted to test whether unipolar and bipolar electrograms would facilitate the ablation procedure when compared to bipolar electrograms alone during PV isolation in patients with atrial fibrillation (AF). In 44 consecutive patients with paroxysmal AF, 114 PVs were randomized to segmental ostial ablation guided by unipolar and bipolar electrograms (61) or by bipolar electrograms only (53). Segmental ostial ablation guided by unipolar and bipolar electrograms was associated with a ∼ 20–30% decrease in the procedure and fluoroscopy times necessary for isolation of a PV and also in the duration of radiofrequency energy application required for complete isolation of a PV. Although the sample size was not sufficient to detect a 5% change, the success rate for complete electrical isolation and the risk of symptomatic PV stenosis were similar between the 2 groups. Online analysis of unipolar electrograms facilitated the PV isolation procedure and was incremental to the analysis of bipolar electrograms alone. However, because segmental ostial ablation has only modest efficacy in achieving long-term freedom from recurrent AF, alternative ablation strategies that may or may not target PVs will eventually evolve. The role of unipolar electrograms in these new methods remains to be determined.en_US
dc.format.extent90802 bytes
dc.format.extent3115 bytes
dc.format.mimetypeapplication/pdf
dc.format.mimetypetext/plain
dc.language.isoen_US
dc.publisherKluwer Academic Publishers; Springer Science+Business Mediaen_US
dc.subject.otherMedicine & Public Healthen_US
dc.subject.otherCardiologyen_US
dc.subject.otherAtrial Fibrillationen_US
dc.subject.otherPulmonary Veinen_US
dc.subject.otherCatheter Ablationen_US
dc.subject.otherElectrogramen_US
dc.subject.otherUnipolaren_US
dc.titleConducting Randomized Trials in the Electrophysiology Laboratory: Lessons from a Randomized Comparison of Recording Methods During Pulmonary Vein Isolation by Segmental Ostial Ablationen_US
dc.typeArticleen_US
dc.subject.hlbsecondlevelMolecular, Cellular and Developmental Biologyen_US
dc.subject.hlbtoplevelHealth Sciencesen_US
dc.subject.hlbtoplevelScienceen_US
dc.description.peerreviewedPeer Revieweden_US
dc.contributor.affiliationumDivision of Cardiology, University of Michigan, Ann Arbor, MI, USAen_US
dc.contributor.affiliationumDivision of Cardiology, University of Michigan, Ann Arbor, MI, USAen_US
dc.contributor.affiliationumcampusAnn Arboren_US
dc.identifier.pmid14739723en_US
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/44683/1/10572_2004_Article_5253491.pdfen_US
dc.identifier.doihttp://dx.doi.org/10.1023/B:CEPR.0000012392.47852.e8en_US
dc.identifier.sourceCardiac Electrophysiology Reviewen_US
dc.owningcollnameInterdisciplinary and Peer-Reviewed


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