title: Simultaneous isolation of superior and inferior pulmonary veins on both the left and right sides could yield better outcomes in patients with paroxysmal atrial fibrillation.
abstract: OBJECTIVE
  This study investigated whether disappearance patterns of pulmonary vein (PV) potentials (PVPs) during PV isolation (PVI) affect the outcome of catheter ablation (CA) in patients with paroxysmal atrial fibrillation (PAF).
  
  
  RESULTS
  Extensive PVI was performed in 1149 PAF patients (age, 61 ± 10 years). Clinical and demographic characteristics, ablation data, and follow-up outcomes were prospectively collected. During an initial CA, simultaneous disappearance of superior and inferior PVPs in both right and left PVs was observed in 464 (40.4%) patients (Group S). Atrial fibrillation-recurrence free rates at 1, 3, and 5 years after the initial CA in Group S were 78.9, 71.9, and 68.1%, respectively, which were higher than those in Group Non-S (P = 0.004). However, those were similar after the final CA between both groups. The incidence of PV-left atrium (LA) electrical reconnection was significantly lower in Group S than in Group Non-S in the second (Group S, 65.6% vs. Group Non-S, 82.1%; P = 0.004) and third (Group S, 8.3% vs. Group Non-S, 47.6%; P = 0.03) CAs. Furthermore, the reconnections more frequently occurred on the side of PVs where simultaneous PVP elimination had not been achieved at the initial CA. Simultaneous disappearance of superior and inferior PVPs in both right and left PVs independently reduced the risk of AF recurrence after the initial CA by 26%.
  
  
  CONCLUSIONS
  The simultaneous disappearance of superior and inferior PVPs in both right and left PVs is associated with less frequent PV-left atrium reconnection and may yield a better clinical outcome after the initial CA.
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan teru.takigawa@gmail.com.
authors.forename: Masateru
authors.initials: M
authors.lastname: Takigawa
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan.
authors.forename: Taishi
authors.initials: T
authors.lastname: Kuwahara
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Okubo
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan.
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan.
authors.forename: Emiko
authors.initials: E
authors.lastname: Nakashima
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Yamao
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watari
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nakajima
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan.
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Fujino
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kimura
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hikita
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.affiliation: Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Carina; Catheter ablation; Pulmonary vein isolation; Pulmonary vein potentials; Reconnection; Recurrence