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


RESULTS
Pulmonary vein mapping and successful PVI were performed using a computerized three-dimensional mapping system (QMS2trade mark) 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.


CONCLUSIONS
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.
Yamada
Takumi
T
Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, 2135 Kariyasuka, Ichinomiya 491-0934 Japan. takumi-y@fb4.so.net.net.jp
Murakami
Yoshimasa
Y
Okada
Taro
T
Okamoto
Mitsuhiro
M
Shimizu
Takeshi
T
Toyama
Junji
J
Yoshida
Yukihiko
Y
Tsuboi
Naoya
N
Ito
Teruo
T
Muto
Masahiro
M
Kondo
Takahisa
T
Inden
Yasuya
Y
Hirai
Makoto
M
Murohara
Toyoaki
T
D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D019233:Retreatment