{"title":"Identification of epicardial connections can improve the success rate of first-pass right pulmonary vein isolation","authors":"Tadashi Wada MD, Keita Matsuo MD, Shin Takayama MD, Masahiko Ochi MD, Yurie Arisuda MD, Hiroaki Akai MD, Yuji Koide MD, Hiroaki Otsuka MD, Kenji Kawamoto MD, Machiko Tanakaya MD, Yusuke Katayama MD","doi":"10.1016/j.hroo.2024.03.011","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Epicardial connections between the right pulmonary vein (PV) and the right atrium have been reported.</p></div><div><h3>Objective</h3><p>The purpose of this study was to evaluate the usefulness of our new pulmonary vein isolation (PVI) strategy with identification of these epicardial connections.</p></div><div><h3>Methods</h3><p>Overall, 235 patients with atrial fibrillation were included. High-density mapping of the left atrium was performed to identify the earliest activation sites (EASs) before PVI in all patients. With our new strategy, if EASs around the right PV carina were identified, we ablated these sites and performed usual first-pass circumferential PVI. The patients were divided into 2 groups according to the ablation strategy. One hundred fifteen patients underwent first-pass PVI without information on EASs (nonanalyzed group), and 78 patients underwent ablation at EASs around the right PV carina in addition to PVI (analyzed group). After first-pass ablation around the PV antrum, remapping was performed.</p></div><div><h3>Results</h3><p>High-density mapping before PVI showed that the prevalence of EASs around the right PV carina was 10.9% in all patients (9.6% in the nonanalyzed group, 12.8% in the analyzed group; <em>P</em> = .74. The first-pass right PVI success rate was higher in the analyzed group than in the nonanalyzed group (93.6% vs 82.6%; <em>P</em> = .04). The radiofrequency application time for PVI was significantly shorter in the analyzed group than in the nonanalyzed group (45.6 ± 1.0 minutes vs 51.2 ± 0.9 minutes; <em>P</em> <.05).</p></div><div><h3>Conclusion</h3><p>Identification of epicardial connections before ablation could improve the success rate of first-pass right PVI.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 5","pages":"Pages 266-273"},"PeriodicalIF":2.5000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266650182400093X/pdfft?md5=4348620b24b583d012538c7c41ca2e69&pid=1-s2.0-S266650182400093X-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart Rhythm O2","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S266650182400093X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
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Abstract
Background
Epicardial connections between the right pulmonary vein (PV) and the right atrium have been reported.
Objective
The purpose of this study was to evaluate the usefulness of our new pulmonary vein isolation (PVI) strategy with identification of these epicardial connections.
Methods
Overall, 235 patients with atrial fibrillation were included. High-density mapping of the left atrium was performed to identify the earliest activation sites (EASs) before PVI in all patients. With our new strategy, if EASs around the right PV carina were identified, we ablated these sites and performed usual first-pass circumferential PVI. The patients were divided into 2 groups according to the ablation strategy. One hundred fifteen patients underwent first-pass PVI without information on EASs (nonanalyzed group), and 78 patients underwent ablation at EASs around the right PV carina in addition to PVI (analyzed group). After first-pass ablation around the PV antrum, remapping was performed.
Results
High-density mapping before PVI showed that the prevalence of EASs around the right PV carina was 10.9% in all patients (9.6% in the nonanalyzed group, 12.8% in the analyzed group; P = .74. The first-pass right PVI success rate was higher in the analyzed group than in the nonanalyzed group (93.6% vs 82.6%; P = .04). The radiofrequency application time for PVI was significantly shorter in the analyzed group than in the nonanalyzed group (45.6 ± 1.0 minutes vs 51.2 ± 0.9 minutes; P <.05).
Conclusion
Identification of epicardial connections before ablation could improve the success rate of first-pass right PVI.
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