Pulmonary vein antrum not always coaxial to the pulmonary vein: a dimensional pitfall to the circumferential isolation technique.
BACKGROUND
The dimensions and electrophysiological characteristics of the antral region of human pulmonary veins (PVs) were investigated.


RESULTS
Fifty-five consecutive patients with symptomatic paroxysmal atrial fibrillation underwent PV isolation targeting the PV antrum potentials with a 31 mm multielectrode basket catheter (MBC). The most distal and proximal electrode pairs along the MBC spline where radiofrequency ablation was carried out were identified and the longitudinal distance between those ablation sites (Ld) was measured. When the Ld was > or =6 mm, the PV antrum was defined as noncoaxial. In 56% of the left superior PVs, 42% of the right superior PVs, 63% of the left inferior PVs and 56% of the right inferior PVs, a noncoaxial PV antrum was identified. In each PV, the radiofrequency ablation delivery duration and energy to complete the PV antrum isolation were significantly larger in the PVs with a noncoaxial PV antrum than in those with a coaxial PV antrum.


CONCLUSIONS
The PV antrum is noncoaxial to the PV in >50% of the PVs, a feature that may increase the complexity of the circumferential isolation technique.
Yamada
Takumi
T
Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL 35294-0019, USA. takumi-y@fb4.so-net.ne.jp
Murakami
Yoshimasa
Y
Okada
Taro
T
Yoshida
Naoki
N
Toyama
Junji
J
Yoshida
Yukihiko
Y
Tsuboi
Naoya
N
Inden
Yasuya
Y
Hirai
Makoto
M
Murohara
Toyoaki
T
D000368:Aged; D001281:Atrial Fibrillation / Q000473:pathology* / Q000503:physiopathology*; D017115:Catheter Ablation; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000473:pathology* / Q000503:physiopathology*; D013614:Tachycardia, Paroxysmal / Q000473:pathology / Q000503:physiopathology