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Role of residual potentials inside circumferential pulmonary veins ablation lines in the recurrence of paroxysmal atrial fibrillation

Authors
 YONG-HYUN KIM  ;  HONG EUY LIM  ;  HUI-NAM PAK  ;  JAE-JIN KWAK  ;  JAE-SEOK PARK  ;  JONG-IL CHOI  ;  SANG-WEON PARK  ;  YOUNG-HOON KIM 
Citation
 JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Vol.21(9) : 959-965, 2010 
Journal Title
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
ISSN
 1045-3873 
Issue Date
2010
MeSH
Action Potentials ; Adult ; Aged ; Atrial Fibrillation/physiopathology ; Atrial Fibrillation/surgery* ; Atrial Flutter/etiology ; Atrial Flutter/physiopathology ; Catheter Ablation*/adverse effects ; Chi-Square Distribution ; Electrocardiography, Ambulatory ; Electrophysiologic Techniques, Cardiac ; Female ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Veins/physiopathology ; Pulmonary Veins/surgery* ; Recurrence ; Republic of Korea ; Risk Assessment ; Risk Factors ; Treatment Outcome
Keywords
atrial fibrillation ; atrial flutter ; catheter ablation ; electroanatomical mapping ; pulmonary vein isolation
Abstract
BACKGROUND: Residual gaps due to incomplete ablation lines are known to be the most common cause of recurrent atrial fibrillation (AF) after catheter ablation. We hypothesized that any residual potentials at the junction of the left atrium and pulmonary vein (PV), inside the circumferential PV ablation (CPVA) lines, would contribute to the recurrence of AF or post-AF ablation atrial flutter (AFL); therefore, the elimination of these potentials increases AF-/AFL-free survival rates.

METHODS AND RESULTS: One hundred and two patients with paroxysmal AF (PAF) were enrolled and prospectively randomized to a group with ablation of residual potentials as add-on therapy to CPVA + PV electrical isolation (PVI) (group 1, n = 49), or a group without ablation of the residual potentials (group 2, n = 53). Post-CPVA residual potentials, inside the ablation lines, were identified by contact bipolar electrode mapping catheter and a detailed 3-dimensional voltage map. Twenty-three patients in group 1 and 18 patients in group 2 had post-CPVA residual potentials (46.9% vs 34.0%, P = 0.182). The AF-/AFL-free survival rate during follow-up of 23.3 ± 7.9 months was not different in comparisons between the 2 groups (P = 0.818), and 79.6% and 81.1% of the patients in groups 1 and 2 maintained a sinus rhythm (P = 0.845), respectively.

CONCLUSIONS: Residual potentials inside CPVA were commonly found in the patients with PAF after CPVA + PVI. Further ablation of residual potentials did not increase the efficacy of catheter ablation in patients with PAF.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/j.1540-8167.2010.01748.x/abstract
DOI
10.1111/j.1540-8167.2010.01748.x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/103115
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