Cor Vasa 2014, 56(1):e11-e18 | DOI: 10.1016/j.crvasa.2013.12.002

Distribution of electrical reconnection after pulmonary vein isolation using a duty-cycled radiofrequency circular ablation catheter

Alan Bulava^a,b,*, Jiří Haniš^a

^a Kardiologické oddělení, Nemocnice České Budějovice, a. s., Česká republika

^b Zdravotně sociální fakulta, Jihočeská univerzita v Českých Budějovicích, Česká republika

Background: Circular ablation catheters (PVAC) have been shown to be effective in the treatment of patients with paroxysmal atrial fibrillation (PAF). The electrophysiological characteristics of the pulmonary veins (PVs) during repeat procedures remain unknown.

Objective: To assess the efficacy of PV isolation (PVI) using PVAC and to determine the typical sites of electrical reconnection (ER) of PVs.

Methods: 79 patients with PAF underwent PVI using PVAC. Those who remained symptomatic underwent repeat procedure using a high-density 3D electroanatomical mapping to determine the sites of ERs.

Results: In total, AF recurrence was documented in 33 patients (41.7%) during the mean follow-up of 1 427 ± 378 days. Twenty-two patients had a further ablation. ER of at least one PV was found in all patients. Left upper, left lower, left common, right upper and right lower PV showed ER in 15, 13, 3, 13 and 12 patients, respectively. There was no difference in number of ERs between individual PVs. In the left upper and left lower PV, 91.7% and 87.5% of gaps, respectively, were localized on the lateral ridge or carina. Sites of ER in the right upper PV were clustered either in the posterior superior (75%) or anterior inferior (25%) quadrants of the vein. Reconnection sites in the right lower PV were scattered equally around its whole circumference.

Conclusion: Typical sites of PV ER are carina and the lateral ridge of the left PVs and superior-posterior aspect of the right upper PV, whereas right lower PV seems to have no typical "reconnection profile".

Keywords: Atrial fibrillation; Multielectrode ablation catheter; Phased array; Pulmonary vein reconnection; PVAC

Received: September 21, 2013; Revised: December 11, 2013; Accepted: December 12, 2013; Published: February 1, 2014  Show citation