title: Patterns of pulmonary vein potential disappearance during encircling ipsilateral pulmonary vein isolation can predict recurrence of atrial fibrillation.
abstract: BACKGROUND
  The relationship between pulmonary vein (PV) potential (PVP) disappearance patterns during encircling ipsilateral pulmonary vein isolation (EIPVI) of atrial fibrillation (AF), and outcome was examined.
  
  
  RESULTS
  A total of 352 consecutive AF patients (age, 61±12 years; 269 men, 76.4%; paroxysmal AF, n=239; persistent AF, n=73; and long-standing persistent AF, n=40) who underwent initial AF ablation were studied. After EIPVI with a double Lasso technique, pacing was performed from the PV carina to confirm isolation of the carina. PVP disappearance patterns were classified into 3 types: A, both superior and inferior PVP disappeared simultaneously; B, superior and inferior PVP disappeared separately; and C, additional RF applications were required inside the encircling lesions to eliminate the PVP after creating anatomical encircling lesions. The relationship between these patterns and outcome was examined. Six groups were defined according to the combination of right and left ipsilateral PVP disappearance patterns. The incidence of A-A, A-B, B-B, A-C, B-C, and C-C was 7.1%, 14.2%, 16.2%, 15.3%, 27.3%, and 19.9%, respectively. AF recurrence-free rate at 2 years for these 6 groups was 96%, 81%, 78%, 64%, 64%, and 59%, respectively (P<0.02). The incidence of a carina isolation was 153/154 (99.4%) for type A, 221/259 (85.3%) for type B, and 145/290 (50.0%) for type C.
  
  
  CONCLUSIONS
  PVP disappearance pattern during EIPVI was significantly associated with the incidence of residual PV carina conduction and AF recurrence.
authors.affiliation: Department of Cardiology, Nagoya Daini Red Cross Hospital.
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: D000368:Aged; D001281:Atrial Fibrillation / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000473:pathology / Q000503:physiopathology*; D012189:Retrospective Studies