The important role of pulmonary vein carina ablation as an adjunct to circumferential pulmonary vein isolation.
OBJECTIVE
The success rate of achieving electrical isolation by circumferential pulmonary vein ablation (CPVA) varies from 32% to 88%. We carried out ablation at the pulmonary vein carina to evaluate the elimination rates of the pulmonary vein potentials (PVPs) after one round of CPVA had failed to eliminate all the PVPs in the patients with atrial fibrillation (AF).


METHODS
Ninety-seven patients (75 males; mean age: 50 +/- 12 years; 15 with persistent AF and 82 with paroxysmal AF) who underwent catheter ablation were analyzed. All patients underwent one round of CPVA with PVP elimination as the endpoint. The electrophysiology tracings were then analyzed to look for the presence of any gaps that were subsequently targeted by radiofrequency ablation. The patients in whom the PVPs still persisted underwent ablation at the pulmonary vein carina and the success rate of the PVP elimination was studied. The patients were followed up for a mean duration of 12.9 +/- 8.2 months.


RESULTS
One hundred ninety-four ipsilateral pulmonary veins in 97 patients were subjected to CPVA with successful elimination of the PVPs in 110 ipsilateral pulmonary veins (success rate of 56.7%). A carina ablation was carried out in the remaining 84 ipsilateral pulmonary vein pairs harboring PVPs. Elimination of the PVPs was achieved in all the remaining ipsilateral pulmonary veins after the carina ablation.


CONCLUSIONS
Considering the limited efficacy of CPVA in eliminating the PVPs, pulmonary vein carina ablation is advisable to substantially increase the PVP elimination rate.
Udyavar
Ameya R
AR
Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, School of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Chang
Shih-Lin
SL
Tai
Ching-Tai
CT
Lin
Yenn-Jiang
YJ
Lo
Li-Wei
LW
Tuan
Ta-Chuan
TC
Tsao
Hsuan-Ming
HM
Hsieh
Ming-Hsiung
MH
Hu
Yu-Feng
YF
Chiang
Shuo-Ju
SJ
Chen
Yi-Jen
YJ
Wongcharoen
Wanwarang
W
Higa
Satoshi
S
Ueng
Kwo-Chang
KC
Chen
Shih-Ann
SA
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000294:innervation / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome