Journal Article

Incidence, location, and cause of recovery of electrical connections between the pulmonary veins and the left atrium after pulmonary vein isolation

Takumi Yamada, Yoshimasa Murakami, Taro Okada, Mitsuhiro Okamoto, Takeshi Shimizu, Junji Toyama, Yukihiko Yoshida, Naoya Tsuboi, Teruo Ito, Masahiro Muto, Takahisa Kondo, Yasuya Inden, Makoto Hirai and Toyoaki Murohara

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 8, issue 3, pages 182-188
Published in print March 2006 | ISSN: 1099-5129
Published online February 2006 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eul002
Incidence, location, and cause of recovery of electrical connections between the pulmonary veins and the left atrium after pulmonary vein isolation

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Aims The aim of this study was to reveal the incidence, location, and cause of recovery of the electrical connections (ECs) between the left atrium and the pulmonary veins (PVs) after the segmental ostial PV isolation (PVI).

Methods and results Pulmonary vein mapping and successful PVI were performed using a computerized three-dimensional mapping system (QMS2™) with a basket catheter in 167 PVs in 53 consecutive patients with atrial fibrillation (AF). In 14 patients with recurrent AF after PVI, the same PV mapping and isolation as in the first procedure were performed, and the PV potential maps constructed by QMS2 in two different procedures were compared. Forty-nine recovered ECs were observed in 27 PVs, and all were eliminated by a few local radiofrequency (RF) applications. Thirty-four (69%) of those ECs recovered at the edge of original ECs, and another 15 (31%) recovered at the mid-portion of the continuous broad original ECs.

Conclusion Electrical connection recovery occurred most commonly at the edges of original ECs and occasionally at the mid-portion of continuous broad original ECs after PVI probably due to tissue oedema neighbouring the segmental RF lesions. Further RF lesions at the edge of original ECs and linear ablation to the continuous broad ECs may help reduce AF recurrence.

Keywords: Atrial fibrillation; Pulmonary veins; Multielectrode basket catheter; Three-dimensional potential mapping; Radiofrequency catheter ablation

Journal Article.  4286 words.  Illustrated.

Subjects: Cardiovascular Medicine

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