Identification of epicardial connections can improve the success rate of first-pass right pulmonary vein isolation

Abstract

BackgroundEpicardial connections between the right pulmonary vein (PV) and the right atrium have been reported. ObjectiveWe evaluated the usefulness of our new PV isolation (PVI) strategy with identification of these epicardial connections. MethodsOverall, 235 patients with atrial fibrillation were included. High-density mapping of the left atrium was performed to identify the earliest activation sites (EASs) before PVI in all patients. With our new strategy, if we identified EASs around the right PV carina, we ablated these sites in addition to performing usual first-pass circumferential PVI. The patients were divided into two groups according to the ablation strategy. One hundred fifteen patients underwent first-pass PVI without information on EASs (non-analyzed group), and 78 patients underwent ablation at EASs around the right PV carina in addition to PVI (analyzed group). After first-pass ablation around the PV antrum, re-mapping was performed. ResultsHigh-density mapping before PVI showed that the prevalence of EASs around the right PV carina was 10.9% in all patients (9.6% in the non-analyzed group and 12.8% in the analyzed group; p = 0.74. The first-pass right PVI success rate was higher in the analyzed group than in the non-analyzed group (93.6% vs. 82.6%; p = 0.04). The radiofrequency application time for PVI was significantly shorter in the analyzed group than in the non-analyzed group (45.6 ± 1.0 min vs. 51.2 ± 0.9 min; p < 0.05). ConclusionIdentification of epicardial connections before ablation could improve the success rate of first-pass right PVI.