Role of residual potentials inside circumferential pulmonary veins ablation lines in the recurrence of paroxysmal atrial fibrillation.
BACKGROUND
Residual gaps due to incomplete ablation lines are known to be the most common cause of recurrent atrial fibrillation (AF) after catheter ablation. We hypothesized that any residual potentials at the junction of the left atrium and pulmonary vein (PV), inside the circumferential PV ablation (CPVA) lines, would contribute to the recurrence of AF or post-AF ablation atrial flutter (AFL); therefore, the elimination of these potentials increases AF-/AFL-free survival rates.


RESULTS
One hundred and two patients with paroxysmal AF (PAF) were enrolled and prospectively randomized to a group with ablation of residual potentials as add-on therapy to CPVA + PV electrical isolation (PVI) (group 1, n = 49), or a group without ablation of the residual potentials (group 2, n = 53). Post-CPVA residual potentials, inside the ablation lines, were identified by contact bipolar electrode mapping catheter and a detailed 3-dimensional voltage map. Twenty-three patients in group 1 and 18 patients in group 2 had post-CPVA residual potentials (46.9% vs 34.0%, P = 0.182). The AF-/AFL-free survival rate during follow-up of 23.3 ± 7.9 months was not different in comparisons between the 2 groups (P = 0.818), and 79.6% and 81.1% of the patients in groups 1 and 2 maintained a sinus rhythm (P = 0.845), respectively.


CONCLUSIONS
Residual potentials inside CPVA were commonly found in the patients with PAF after CPVA + PVI. Further ablation of residual potentials did not increase the efficacy of catheter ablation in patients with PAF.
Kim
Yong-Hyun
YH
Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Lim
Hong Euy
HE
Pak
Hui-Nam
HN
Kwak
Jae-Jin
JJ
Park
Jae-Seok
JS
Choi
Jong-Il
JI
Park
Sang-Weon
SW
Kim
Young-Hoon
YH
D000200:Action Potentials; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D001282:Atrial Flutter / Q000209:etiology / Q000503:physiopathology; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome