title: Electrical connections between pulmonary veins: implication for ostial ablation of pulmonary veins in patients with paroxysmal atrial fibrillation.
abstract: BACKGROUND
  Electrical disconnection of the myocardial extensions into arrhythmogenic pulmonary veins (PVs) is recognized as a curative technique for paroxysmal atrial fibrillation (AF). However, the presence of electrical connections between the PVs, which may make achievement of PV disconnection difficult, has not been systematically evaluated.
  
  
  RESULTS
  Forty-nine consecutive patients with drug-resistant AF underwent ostial radiofrequency (RF) catheter ablation of arrhythmogenic PVs with foci triggering AF. Pacing from inside the targeted PV was performed after each RF delivery to identify the left atrial exit site of the residual venoatrial conduction. Successful PV disconnection was defined as achieving elimination of the PV potentials during sinus rhythm or left atrial pacing, and the loss of left atrial conduction during intra-PV pacing. A total of 112 arrhythmogenic PVs were identified. PV disconnection was achieved with 10+/-6.1 minutes of RF delivery to the ostia of 101 targeted PVs. In 7 left superior (LS) PVs from 7 patients (14%), the earliest atrial activity was recorded from the left inferior (LI) PV ostium during intra-LSPV pacing after 11+/-4.7 minutes of RF delivery to the LSPV ostium. Disconnection of these LSPVs was achieved by LIPV disconnection. In the remaining 4 PVs from 4 patients, PV disconnection could not be achieved.
  
  
  CONCLUSIONS
  Fourteen percent of the patients had electrical connections between contiguous PVs. In these patients, ostial ablation of an untargeted PV was required for successful targeted PV disconnection.
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura-shi, Ibaraki-ken, Japan. atsushija@aol.com
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Ryoko
authors.initials: R
authors.lastname: Takahashi
authors.forename: Kenzaburo
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Takagi
authors.forename: Osamu
authors.initials: O
authors.lastname: Kuboyama
authors.forename: Takeo
authors.initials: T
authors.lastname: Nishimori
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Takei
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Amemiya
authors.forename: Hideomi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Masayasu
authors.initials: M
authors.lastname: Hiraoka
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000379:methods*; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology* / Q000601:surgery*