The incidence and clinical significance of non-isolation of the pulmonary vein carina after encircling ipsilateral pulmonary veins isolation for paroxysmal atrial fibrillation: a pitfall of the double-Lasso technique.

Abstract

AIMS:

Encircling ipsilateral pulmonary veins (PVs) isolation (EIPVsI) with the double-Lasso technique has proven to be effective to cure atrial fibrillation (AF). However, in this technique, PV mapping with circular catheters may miss a non-isolation of the PV carina. The purpose of this study was to reveal the incidence and clinical significance of a non-isolation of the PV carina after EIPVsI.

METHODS AND RESULTS:

We studied 81 consecutive paroxysmal AF patients (age 61 ± 12 years, 56 men), in whom EIPVsI was successfully performed in one encircling line with the endpoint of the demonstration of bidirectional conduction block between the PVs and left atrium (LA) with the double-Lasso technique. After a successful EIPVsI, pacing from the PV carina was performed and it captured the LA in 17 (21.0%) patients. During a mean follow-up period of 19 ± 13 months, AF recurred in 13 (16.0%) patients. A multivariate Cox proportional analysis revealed that a non-isolation of the PV carina after the EIPVsI was a significant predictor (hazard ratio = 3.91, 95% confidence interval = 1.13-14.16, P = 0.03) of AF recurrence.

CONCLUSIONS:

Pulmonary vein mapping with the double-Lasso technique did miss the non-isolation of the PV carina after a successful EIPVsI, which was an independent predictor of AF recurrence after the EIPVsI. Pacing from the PV carina may be required to confirm the electrical isolation of the PV carina after EIPVsI with the double-Lasso technique.

• Authors: Masateru Takigawa, Takumi Yamada, Yukihiko Yoshida, Kiyotake Ishikawa, Yutaka Aoyama, Takashi Yamamoto, Natsuo Inoue, Yasushi Tatematsu, Mamoru Nanasato, Kazuo Kato, Naoya Tsuboi, Haruo Hirayama
• Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (Europace) Vol. 15 Issue 1 Pg. 33-40 (Jan 2013) ISSN: 1532-2092 [Electronic] England
• PMID: 22941967 (Publication Type: Controlled Clinical Trial, Journal Article)

Topics

• Atrial Fibrillation (epidemiology, prevention & control, surgery)
• Body Surface Potential Mapping (methods, statistics & numerical data)
• Catheter Ablation (statistics & numerical data)
• Female
• Heart Conduction System (surgery)
• Humans
• Incidence
• Japan (epidemiology)
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Proportional Hazards Models
• Pulmonary Veins (surgery)
• Risk Factors
• Secondary Prevention
• Treatment Failure
• Treatment Outcome