title: High take-off left inferior pulmonary vein as an obstacle in creating a conduction block at the lateral mitral isthmus.
abstract: OBJECTIVE
  Creation of complete linear lesions in the lateral mitral isthmus (LMI) by catheter ablation for treating atrial fibrillation remains technically challenging. We aimed to clarify whether a high take-off left inferior pulmonary vein (LIPV) can hamper the creation of a complete block at the LMI.
  
  
  RESULTS
  We included 81 consecutive patients who underwent linear ablation at the LMI and cardiac computed tomography (CT) before ablation. We defined a high take-off LIPV when the level of the lower edge of the LIPV ostium was higher than that of the top of mitral annulus on CT. The clinical backgrounds, parameters, and long-term follow-up were then compared between the success (successful creation of a complete LMI block) and failure groups. A complete LMI block was obtained in 60/81 (76%) patients. In the failure group, a high take-off LIPV was noted more commonly and the LMI tended to be longer than the success group. Multivariate analysis revealed that a high take-off LIPV was an independent predictor of failure to achieve a complete LMI block. The sinus rhythm maintenance rate was not different between the success and failure groups.
  
  
  CONCLUSIONS
  A high take-off LIPV hampered the creation of complete linear lesions in the LMI.
authors: Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo 160-8582, Japan. seiji.takatsuki@gmail.com
authors: Seiji
authors: S
authors: Takatsuki
authors: Fabrice
authors: F
authors: Extramiana
authors: Meiso
authors: M
authors: Hayashi
authors: Abdeddayem
authors: A
authors: Haggui
authors: Anne
authors: A
authors: Messali
authors: Paul
authors: P
authors: Milliez
authors: Antoine
authors: A
authors: Leenhardt
authors: Bruno
authors: B
authors: Cauchemez
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000601:surgery*; D016896:Treatment Outcome