Abstract
Purpose: The acute effect of radiofrequency (RF) ablation includes local necrosis and oedema. We investigated the spatiotemporal change of atrial electrograms in the area surrounding the site of single standardized pulse of RF energy.Methods: The study enrolled 12 patients (45–67 years, 10 males) with paroxysmal atrial fibrillation (AF) undergoing ablation procedure with irrigated-tip ablation catheter and 3D navigation. The high-density mapping/remapping (129 ± 63 points) within the circular area with radius of ~10 mm, centered at the pre-specified posterior left pulmonary vein antrum ablation site was performed at baseline, immediately after single RF energy delivery (25 W, 30 s, 20 ml/min) and after 30 min waiting period. Bipolar voltages of atrial electrograms (A-EGM-biV) were averaged within the central and 12 adjacent left atrium segments and their relative change was studied.Results: After the ablation, overall A-EGM-biV within the mapping zone (3.51 ± 1.89 mV at baseline) reduced to 2.83 ± 1.77 mV (immediately) and to 2.68 ± 1.58 mV (after 30 min waiting period). In per-segment pair-wise comparison, we observed highly significant change in A-EGM-biV that extended up to the distance of 8.8 mm from the lesion core. The maximum early A-EGM-biV attenuation by 39–49% (P < 0.001) was registered in segments adjacent to pulmonary vein ostia. The subsequent (delayed) A-EGM-biV reduction by 17–24% (P < 0.05) was observed in opposite direction from the lesion center.Conclusions: Significant alteration of atrial electrograms was detectable rather distant from the central lesion. Spatiotemporal development of ablation lesion was eccentric/asymmetric. While acute A-EGM-biV reduction can be attributed predominantly to direct thermal injury, delayed effects are probably due to oedema progression.
Highlights
Pulmonary vein (PV) isolation (PVI) for atrial fibrillation (AF) is an established therapy in selected patients [1]
In the absence of cellular death, reversible tissue oedema or thermal stunning may account for the discordance between the incidence of acute and chronic PVI [5,6,7], because injured, but still viable, myocardium may eventually recover its conduction properties and result in late PV reconnection [8]
Consecutive patients undergoing PVI for paroxysmal AF without structural heart disease who had no low voltage areas identified at the posterior left atrial (LA) wall during point-bypoint electroanatomic mapping and who were in sinus rhythm at the beginning of the study protocol were enrolled
Summary
Pulmonary vein (PV) isolation (PVI) for atrial fibrillation (AF) is an established therapy in selected patients [1]. Resumption of PV-left atrial (LA) conduction is exceedingly common and thought to be responsible for the vast majority of post-ablation atrial tachyarrhythmia recurrences [2]. It is well-known, that the acute effect of radiofrequency (RF) ablation consists of local necrosis, collateral oedema, and atrial stunning [3, 4]. In the absence of cellular death, reversible tissue oedema or thermal stunning may account for the discordance between the incidence of acute and chronic PVI [5,6,7], because injured, but still viable, myocardium may eventually recover its conduction properties and result in late PV reconnection [8]. The larger distance from endocardiallypositioned catheter bipole may be augmented by the oedema-induced thickening of the atrial wall gaprelated electrical activities might be difficult to identify because of far-field morphology of corresponding A-EGMs [9]
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