Abstract
BackgroundThe major cause of recurrence after pulmonary vein (PV) isolation for atrial fibrillation (AF) is PV reconnection, and thicker wall could be associated with reconnection.ObjectivesThis study aimed to evaluate the wall thickness of the PV antrum in reconnection sites using a three-dimensional (3D) wall thickness map.MethodsA total of 91 patients who underwent a second ablation procedure due to AF recurrence were evaluated. The locations of the PV reconnection sites were confirmed in electroanatomical maps. A 3D atrial wall thickness (AWT) map was created using computed tomography scan data. The AWT values of the ablation lines of the index procedure were graded in each segment of the PV antrum: grade 1, 0.5 < AWT ≤ 1.0 mm; grade 2, 1.0 < AWT ≤ 1.5 mm; grade 3, 1.5 < AWT ≤ 2.0 mm; grade 4, 2.0 < AWT ≤ 2.5 mm; grade 5, AWT > 2.5 mm.ResultsA total of 281 PV reconnection sites among 1256 segments of the PV antrum in 79 patients were detected. The average AWT grades were 2.7 ± 1.0 and 2.2 ± 1.0 in the reconnected and non-reconnected segments, respectively (P < 0.01). Higher AWT grades were observed in the reconnected superior segments of the left superior PV, carina and inferior segments of the left inferior PV, superior and posterior segments of the right superior PV, and posterior and inferior segments of the right inferior PV.ConclusionThe reconnected segments of the PV antrum showed thicker myocardium than the non-reconnected ones in patients with recurrent AF after catheter ablation. A wall thickness map for PV isolation could be considered for customized ablation in order to reduce PV reconnection.
Highlights
Atrial fibrillation (AF) is the most common sustained arrhythmia, and multiple mechanisms are involved in its pathophysiology [1]
A wall thickness map for pulmonary vein (PV) isolation could be considered for customized ablation in order to reduce PV reconnection
The most important anatomical structure related to atrial fibrillation (AF) trigger is the pulmonary vein (PV), which was demonstrated by Haissaguerre et al.’s
Summary
Atrial fibrillation (AF) is the most common sustained arrhythmia, and multiple mechanisms are involved in its pathophysiology [1]. Oh et al Int J Arrhythm (2021) 22:16 landmark study [2]. Based on these findings, electrical isolation of the PV is an essential part of catheter ablation for AF [3]. Despite the development of new technologies for catheter ablation, the recurrence rates after PV isolation remain relatively high. The recurrence rates range from 25 to 40% from 3 months to 1 year after PV isolation [3]. PV reconnection is a major cause of recurrence after PV isolation procedure [4, 5]. The major cause of recurrence after pulmonary vein (PV) isolation for atrial fibrillation (AF) is PV recon‐ nection, and thicker wall could be associated with reconnection
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