@article {PAK:September 2007:1045-3873:917,
	author = "PAK, HUI-NAM",
	author = "HWANG, CHUN",
	author = "LIM, HONG EUY",
	author = "KIM, JIN SEOK",
	author = "KIM, YOUNG-HOON",
	title = "Hybrid Epicardial and Endocardial Ablation of Persistent or Permanent Atrial Fibrillation: A New Approach for Difficult Cases",
	journal = "Journal of Cardiovascular Electrophysiology",
	volume = "18",
	year = "September 2007",
	abstract = "Epicardial AF Ablation.&#8194;<P></P><I>Background</I>: Although percutaneous epicardial catheter ablation (PECA) has been used for the management of epicardial ventricular tachycardia, the use of PECA for atrial fibrillation (AF) has not yet been reported. <P></P><I>Objective:</I> To evaluate the efficacy and feasibility of a hybrid PECA and endocardial ablation for AF. <P></P><I>Methods:</I> We performed PECA for AF in five patients (48.6 &#177; 8.1 years old, all male, four redo ablation procedures of persistent AF with a risk of pulmonary vein (PV) stenosis, one de novo ablation of permanent &#91;AF&#93;) after an endocardial AF ablation guided by PV potentials and 3D mapping (NavX). Utilizing an open irrigation tip catheter, a left atrial (LA) linear ablation from the roof to the perimitral isthmus or localized ablation at the junction between the LA appendage and left-sided PVs or ligament of Marshall (LOM) was performed. <P></P><I>Results:</I> PECA of AF was successful in all patients with an ablation time of &#60;15 minutes. The left-sided PV potentials were eliminated by PECA in all patients. Bidirectional block of the perimitral line was achieved in two of two patients and a left inferior PV tachycardia with conduction block to the LA was observed during the ablation in the area of the LOM in one patient. A hemopericardium developed in one patient, but was controlled successfully. During 8.0 &#177; 6.3 months of follow-up, all patients have remained in sinus rhythm (four patients without antiarrhythmic drugs). <P></P><I>Conclusion:</I> A hybrid PECA of AF is feasible and effective in patients with redo-AF ablation procedures and at risk for left-sided PV stenosis or who are resistant to endocardial linear ablation. <P></P><I>(J Cardiovasc Electrophysiol, Vol. 18 pp. 917-923, September 2007)</I>",
	pages = "917-923(7)",
	url = "http://www.ingentaconnect.com/content/bsc/jce/2007/00000018/00000009/art00005"
	doi = "doi:10.1111/j.1540-8167.2007.00882.x"
}