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- Title
Wall thickness of the pulmonary vein-left atrial junction rather than electrical information as the major determinant of dormant conduction after contact force-guided pulmonary vein isolation.
- Authors
Iso, Kazuki; Okumura, Yasuo; Watanabe, Ichiro; Nagashima, Koichi; Sonoda, Kazumasa; Kogawa, Rikitake; Sasaki, Naoko; Takahashi, Keiko; Kurokawa, Sayaka; Nakai, Toshiko; Ohkubo, Kimie; Hirayama, Atsushi
- Abstract
<bold>Purpose: </bold>The usefulness of electrogram (EGM)-based information has been reported for assessing lesion transmurality during atrial fibrillation (AF) ablation, but the wall thickness of the pulmonary vein-left atrial (PV-LA) junction has not been considered. We conducted a study to evaluate the relation between PV-LA junction wall thickness and the presence of adenosine triphosphate (ATP)-provoked dormant PV conduction.<bold>Methods: </bold>Eighteen AF patients underwent extensive encircling pulmonary vein isolation (EEPVI) with a target CF of >10 g. RF energy was delivered point-by-point at a power setting of 25-30 W for 30 s, and EGM-based information (change in filtered unipolar EGM morphology and bipolar EGM amplitude), decrease in impedance, CF, and CT-based measurement of the PV-LA junction wall thickness were characterized at sites of ATP-provoked dormant conduction.<bold>Results: </bold>After EEPVI, ATP-induced dormant conduction was observed at 12 of the 288 PV sites (8 segments per ipsilateral PVs × 2 × 18 patients). Of the 974 ablation points, 72 were located at dormant conduction sites and were strongly associated with thickened PV-LA junction walls (1.02± 0.23 vs. 0.86 ± 0.26 mm, p < 0.0001) and decreased impedance (13.3 ± 6.4 vs. 14.9 ± 7.1 Ω, p = 0.0498) but not with EGM-based information or CF. Multivariate analysis identified the thickened PV-LA junction wall as the strongest predictor of dormant conduction.<bold>Conclusions: </bold>A thickened PV-LA junction wall is a robust predictor of ATP-provoked dormant conduction; EGM-based information appears to be insufficient for ensuring adequate lesions during CF-guided EEPVI.
- Subjects
ATRIAL fibrillation; ABLATION techniques; PULMONARY veins; ADENOSINE triphosphatase; MULTIVARIATE analysis; ATRIAL fibrillation diagnosis; ADENOSINES; ANTHROPOMETRY; CATHETER ablation; CLINICAL trials; COMPARATIVE studies; ELECTROCARDIOGRAPHY; HEART atrium; INTRAOPERATIVE monitoring; RESEARCH methodology; MEDICAL cooperation; RESEARCH; VASODILATORS; EVALUATION research; PHYSIOLOGIC strain; SURGERY
- Publication
Journal of Interventional Cardiac Electrophysiology, 2016, Vol 46, Issue 3, p325
- ISSN
1383-875X
- Publication type
journal article
- DOI
10.1007/s10840-016-0147-0