Abstract
Purpose: To prospectively evaluate the incidence of pulmonary vein (PV) reconnections (PVRs) and identify predictors of PVRs after circumferential PV isolation (CPVI) using a contact force (CF)-sensing ablation catheter. Methods: Sixty-five patients (51-males; 61±10 years) undergoing an initial CPVI were studied. Both the right and left CPVI lines were divided into 12 segments and multiple regression models were used to predict PVRs in the four regions (each including 6 segments), the anterior and posterior RPVs and LPVs (A-RPVs, P-RPVs, A-LPVs, and P-LPVs). Each radiofrequency application was delivered with 15-30W for <30s along the P-LPVs and 30-40W for 40-60s along the others. Results: In 63 reconnected gaps, the right-PVs had more gaps in the anterior and posterior carina, while the left-PVs had more in the posterior carina than elsewhere, respectively (P<0.05). The P-RPVs and P-LPVs had significantly more gaps than the A-LPVs (17 A-RPVs, 21 P-RPVs, 6 A-LPVs, and 19 P-LPVs; P<0.05). The mean CF in the A-RPVs and P-RPVs (odds ratios (ORs), 0.916 and 0.854; P=0.014 and <0.001, respectively) and Force-Power-Time Index (FPTI) in the A-LPVs (OR, 0.99; P=0.012) were significant negative predictors of PVRs. According to the receiver operating characteristics analysis, at optimal cutoffs of mean CFs of 18g (A-RPVs) and 12g (P-RPVs), and FPTI of 36,737g.W.s (A-LPVs), the sensitivity and specificity for predicting PVRs were 81.3% and 61.9%, 71.3% and 52.9%, and 58.6% and 100%, respectively. Conclusions: The carina regions can be common sites for PVRs despite a higher CF and FPTI. An optimal CF and FPTI may be needed to prevent PVRs during an initial CPVI, especially in the RPVs and A-LPVs.
Published Version
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