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Europace Advance Access originally published online on February 10, 2006
Europace 2006 8(3):182-188; doi:10.1093/europace/eul002
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

ELECTROPHYSIOLOGY

Incidence, location, and cause of recovery of electrical connections between the pulmonary veins and the left atrium after pulmonary vein isolation

Takumi Yamada1,*, Yoshimasa Murakami1, Taro Okada1, Mitsuhiro Okamoto1, Takeshi Shimizu1, Junji Toyama1, Yukihiko Yoshida2, Naoya Tsuboi2, Teruo Ito2, Masahiro Muto3, Takahisa Kondo3, Yasuya Inden3, Makoto Hirai3 and Toyoaki Murohara3

1 Division of CardiologyAichi Prefectural Cardiovascular and Respiratory Center2135 Kariyasuka, Yamato-cho, Ichinomiya 491-0934 Japan ; 2 Division of CardiologyNagoya Dai-ni Red Cross HospitalCardiovascular Center, Nagoya Japan ; 3 Department of CardiologyNagoya University Graduate School of MedicineNagoya Japan

Aims The aim of this study was to reveal the incidence, location, and cause of recovery of the electrical connections (ECs) between the left atrium and the pulmonary veins (PVs) after the segmental ostial PV isolation (PVI).

Methods and results Pulmonary vein mapping and successful PVI were performed using a computerized three-dimensional mapping system (QMS2TM) with a basket catheter in 167 PVs in 53 consecutive patients with atrial fibrillation (AF). In 14 patients with recurrent AF after PVI, the same PV mapping and isolation as in the first procedure were performed, and the PV potential maps constructed by QMS2 in two different procedures were compared. Forty-nine recovered ECs were observed in 27 PVs, and all were eliminated by a few local radiofrequency (RF) applications. Thirty-four (69%) of those ECs recovered at the edge of original ECs, and another 15 (31%) recovered at the mid-portion of the continuous broad original ECs.

Conclusion Electrical connection recovery occurred most commonly at the edges of original ECs and occasionally at the mid-portion of continuous broad original ECs after PVI probably due to tissue oedema neighbouring the segmental RF lesions. Further RF lesions at the edge of original ECs and linear ablation to the continuous broad ECs may help reduce AF recurrence.

Key Words: Atrial fibrillation, Pulmonary veins, Multielectrode basket catheter, Three-dimensional potential mapping, Radiofrequency catheter ablation

* Corresponding author. Tel: +81 586 45 5000; fax: +81 586 45 6800. E-mail address: takumi-y{at}fb4.so-net.ne.jp


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