title: The incidence and clinical significance of non-isolation of the pulmonary vein carina after encircling ipsilateral pulmonary veins isolation for paroxysmal atrial fibrillation: a pitfall of the double-Lasso technique.
abstract: OBJECTIVE
  Encircling ipsilateral pulmonary veins (PVs) isolation (EIPVsI) with the double-Lasso technique has proven to be effective to cure atrial fibrillation (AF). However, in this technique, PV mapping with circular catheters may miss a non-isolation of the PV carina. The purpose of this study was to reveal the incidence and clinical significance of a non-isolation of the PV carina after EIPVsI.
  
  
  RESULTS
  We studied 81 consecutive paroxysmal AF patients (age 61 ± 12 years, 56 men), in whom EIPVsI was successfully performed in one encircling line with the endpoint of the demonstration of bidirectional conduction block between the PVs and left atrium (LA) with the double-Lasso technique. After a successful EIPVsI, pacing from the PV carina was performed and it captured the LA in 17 (21.0%) patients. During a mean follow-up period of 19 ± 13 months, AF recurred in 13 (16.0%) patients. A multivariate Cox proportional analysis revealed that a non-isolation of the PV carina after the EIPVsI was a significant predictor (hazard ratio = 3.91, 95% confidence interval = 1.13-14.16, P = 0.03) of AF recurrence.
  
  
  CONCLUSIONS
  Pulmonary vein mapping with the double-Lasso technique did miss the non-isolation of the PV carina after a successful EIPVsI, which was an independent predictor of AF recurrence after the EIPVsI. Pacing from the PV carina may be required to confirm the electrical isolation of the PV carina after EIPVsI with the double-Lasso technique.
authors.affiliation: Department of Cardiology,  Nagoya Daini Red Cross Hospital, Nagoya,  Japan.
authors.forename: Masateru
authors.initials: M
authors.lastname: Takigawa
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamada
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Kiyotake
authors.initials: K
authors.lastname: Ishikawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Aoyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Natsuo
authors.initials: N
authors.lastname: Inoue
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tatematsu
authors.forename: Mamoru
authors.initials: M
authors.lastname: Nanasato
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kato
authors.forename: Naoya
authors.initials: N
authors.lastname: Tsuboi
authors.forename: Haruo
authors.initials: H
authors.lastname: Hirayama
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000517:prevention & control / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods / Q000706:statistics & numerical data*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000601:surgery*; D012307:Risk Factors; D055502:Secondary Prevention; D017211:Treatment Failure; D016896:Treatment Outcome