title: Errors in pulmonary vein identification and ostia location in the absence of pulmonary vein imaging.
abstract: BACKGROUND
  A key point in atrial fibrillation (AF) ablation is the ability to identify the pulmonary vein (PVs) and locate their ostia.
  
  
  OBJECTIVE
  The purpose of this study was to assess the error margin of PV identification and ostia location in the absence of previous PV imaging.
  
  
  METHODS
  This study was performed in patients referred for catheter ablation of AF. PVs were reconstructed before ablation using the CARTO system. The operator tagged the superior and inferior edges of the PV ostia before and after examining the corresponding PV angiograms. The distances between the tagged PV ostia were measured using CARTO software.
  
  
  RESULTS
  A total of 105 location estimations of 54 PVs were analyzed. The location of PV ostia without angiography deviated from the angiographic PV ostia by a median of 13 mm (95% confidence interval = 11-14 mm; P < .0001). In 84 of the 105 estimations (80%), wrong tagging was performed inside the PV. A multiple logistic regression revealed that, at sites displaying PV potentials, the left atrial potential amplitude was an independent predictor of location at the angiographic PV ostium (odds ratio 24 [95% confidence interval = 3.7-227] per 1-mV increase). Receiver operator characteristic analysis set the optimal cutoff level at 0.7 mV. Use of this criterion improved the accuracy of PV ostium location by 4 mm (95% confidence interval = 1-6 mm; P = .005).
  
  
  CONCLUSIONS
  Attempts at PV identification and ostia location in the absence of previous PV imaging are subject to a broad error margin.
authors.affiliation: Unit of Arrhythmias, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain. nperez.hcsc@salud.madrid.org
authors.forename: Nicasio
authors.initials: N
authors.lastname: Pérez-Castellano
authors.forename: Julián
authors.initials: J
authors.lastname: Villacastín
authors.forename: Javier
authors.initials: J
authors.lastname: Moreno
authors.forename: Aníbal
authors.initials: A
authors.lastname: Rodríguez
authors.forename: Mauricio
authors.initials: M
authors.lastname: Moreno
authors.forename: Asunción
authors.initials: A
authors.lastname: Conde
authors.forename: Ricardo
authors.initials: R
authors.lastname: Morales
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D016275:Atrial Function / Q000502:physiology; D017115:Catheter Ablation; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D016896:Treatment Outcome