Pulmonary Vein Research Articles

PVI-Only is Not Enough for All Persistent AF Patients: A FLOW-AF Subgroup Analysis

BackgroundSince the STAR-AF II trial, there has been a trend toward pulmonary vein isolation (PVI)-only ablation strategies for persistent atrial fibrillation (PeAF). Electrographic Flow (EGF) mapping can identify active sources of AF and estimate the electrographic flow consistency (EGFC) of wavefront propagation through substrate, revealing functional AF mechanisms. ObjectiveExamine the success of a PVI-only ablation strategy for a redo PeAF/long-standing PeAF population. MethodsFLOW-AF (NCT04473963) prospectively enrolled non-paroxysmal AF patients undergoing redo ablation at 4 centers. One-minute EGF recordings using 64-pole basket catheters were obtained both pre-PVI and post-PVI following a 20-minute wait and confirmation of electrical isolation of veins. Patients with EGF-identified sources were randomized 1:1 to EGF-guided source ablation v. PVI-only. Patients with no sources were not randomized and mostly received PVI-only. ResultsStudy of 85 patients enrolled: 24 with EGF-identified sources randomized to PVI-only and 23 with no sources receiving PVI-only. Of these 47 patients, those with sources (Group 2) had different clinical characteristics including older age and higher CHA2DS2-VASc compared with those with sources (Group 1). After PVI-only, Group 1 had 70% (16/23) freedom from recurrent AF (FFAF) within one year v. Group 2 with 35% (8/23), p=0.018. Additionally, patients with high electrographic flow consistency (EGFC) indicative of healthy or normal substrate had 67% (10/15) FFAF v. 45% (14/31) in those with low EGFC suggestive of abnormal substrate, p=0.011. ConclusionSuccess rate in no sources patients receiving PVI-only is better than in those with sources randomized to PVI-only. For the clinically heterogenous population of PeAF patients, the presence of EGF-identified sources matters clinically, and PVI-only will not be enough for all patients.

A negative relationship between first-pass pulmonary vein isolation and body mass index in ablation index–guided pulmonary vein isolation

BackgroundWe previously reported the relationship between first-pass pulmonary vein isolation (FPI) and pulmonary vein isolation (PVI) durability in ablation index–guided atrial fibrillation ablation. Obesity is a worsening factor for atrial tachyarrhythmia (AT) recurrence. However, the impact of obesity on FPI has been scarcely reported. General anesthesia (GA) facilitates completing PVI by preventing airway obstruction caused by sedative drug use. However, the impact of GA on the relationship also has not been elucidated. ObjectiveThe study sought to evaluate the impact of obesity and its relationship with GA on FPI. MethodsWe retrospectively studied 2187 consecutive patients undergoing ablation index–guided first atrial fibrillation ablation (conscious sedation in 1969 and GA in 218). We divided them into 4 groups according to body mass index (BMI): underweight (BMI < 18.5 kg/m2) (n = 80), normal (18.5 kg/m2 ≤ BMI < 25 kg/m2) (n = 1,160), overweight (25 kg/m2 ≤ BMI < 30 kg/m2) (n = 763), and obesity (BMI ≥30 kg/m2) (n = 184). ResultsFPI rate decreased as BMI increased in both conscious sedation (68.1% in underweight, 61.5% in normal, 48.7% in overweight, and 39.0% in obesity; P < .001) and GA (87.5%, 67.1%, 61.3%, and 44.7%, respectively; P = .01). Multivariate analysis revealed overweight (odds ratio 0.65, 95% confidence interval [CI] 0.53–0.79, P < .001, vs normal) and obesity (OR 0.44, 95% CI 0.31–0.62 P < .001, vs normal) as independent predictors for FPI and obesity as an AT recurrence predictor (hazard ratio 1.35, 95% CI 1.01–1.81, P = .04). ConclusionBMI increase was negatively related to the FPI rate. Notably, the FPI rate in obese patients, even under GA, was low, which might be related to their high AT recurrence.

Characterization and Clinical Significance of Hemolysis After Pulsed Field Ablation for Atrial Fibrillation: Results of a Multicenter Analysis.

Pulsed field ablation (PFA) is increasingly used in clinical practice for the treatment of atrial fibrillation. While the susceptibility of erythrocytes to electroporation is well established, the effect of cardiac PFA technologies on hemolysis has remained underreported. The aim of this study was to investigate the incidence, severity, and clinical impact of PFA-induced hemolysis. We included n=145 patients undergoing atrial fibrillation catheter ablation with a pentaspline PFA catheter (biphasic, bipolar pulses of 2 kV) and n=70 patients receiving radiofrequency ablation (40-90 W) at 4 high-volume European centers. The lesion set comprised pulmonary vein isolation for paroxysmal atrial fibrillation and pulmonary vein isolation±additional lesions for persistent atrial fibrillation. Hemolysis and renal function biomarkers were analyzed in blood samples at baseline, at the end of ablation, and 24 hours after the procedure. Baseline characteristics were well balanced between groups (overall mean, 65.7±9.4 years; 69.3% male). The ablation procedures comprised a mean of 61.6±27.4 PFA deliveries and 26.3±15.0 minute RF duration. Hemolysis was detected in 94.3% versus 6.8% of patients after PFA versus radiofrequency ablation (P<0.001): PFA was associated with significantly lower haptoglobin levels (0.5±0.4 versus 1.0±0.4 g/L), while free plasma hemoglobin (592.8±330.6 versus 147.8±183.0 mg/L), bilirubin (21.3±11.3 versus 14.8±8.8 µmol/L), and LDH (lactate dehydrogenase, 352.7±115.7 versus 253.2±56.5 U/L) were significantly higher after PFA versus radiofrequency ablation (all P<0.001). Hemolysis correlated with the number of PFA deliveries (r=0.62 [95% CI, 0.33-0.80]; P<0.001), with the highest severity occurring ≥54 PFA deliveries. After PFA, hemoglobinuria occurred in 36.4%, while creatinine increase was higher in patients with baseline glomerular filtration rate <50 mL/min versus baseline glomerular filtration rate >50 mL/min (Δcrea, 27.0±103.1 versus -0.2±12.1 µmol/L; P=0.010). Intravascular hemolysis is a frequent finding after PFA and increases with the number of PFA deliveries. Until the clinical impact of PFA-associated hemolysis is fully elucidated, a careful titration of PFA deliveries during the ablation procedure is warranted.

Lesion characteristics using high-frequency low-tidal volume ventilation versus standard ventilation during ablation of paroxysmal atrial fibrillation.

High-frequency low-tidal-volume (HFLTV) ventilation during radiofrequency catheter ablation (RFCA) for paroxysmal atrial fibrillation (PAF) has been shown to be superior to standard ventilation (SV) in terms of procedural efficiency, acute and long-term clinical outcomes. Our study aimed to compare ablation lesions characteristics utilizing HFLTV ventilation versus SV during RFCA of PAF. A retrospective analysis was conducted on patients who underwent pulmonary vein isolation (PVI) for PAF between August 2022 and March 2023, using high-power short-duration ablation. Thirty-five patients underwent RFCA with HFLTV ventilation and were matched with another cohort of 35 patients who underwent RFCA with SV. Parameters including ablation duration, contact force (CF), impedance drop, and ablation index were extracted from the CARTONET database for each ablation lesion. A total of 70 patients were included (HFLTV = 35/2484 lesions, SV = 35/2830 lesions) in the analysis. There were no differences in baseline characteristics between the groups. While targeting the same ablation index, the HFLTV ventilation group demonstrated shorter average ablation duration per lesion (12.3 ± 5.0 vs. 15.4 ± 8.4 s, p < .001), higher average CF (17.0 ± 8.5 vs. 10.5 ± 4.6 g, p < .001), and greater impedance reduction (9.5 ± 4.6 vs. 7.7 ± 4.1 ohms, p < .001). HFLTV ventilation group also demonstrated shorter total procedural time (61.3 ± 25.5 vs. 90.8 ± 22.8 min, p < .001), ablation time (40.5 ± 18.6 vs. 65.8 ± 22.5 min, p < .001), and RF time (15.3 ± 4.8 vs. 22.9 ± 9.7 min, p < .001). HFLTV ventilation during PVI for PAF was associated with improved ablation lesion parameters and procedural efficiency compared to SV.

Multielectrode catheter-based pulsed field ablation of persistent and long-standing persistent atrial fibrillation.

Rhythm control of non-paroxysmal atrial fibrillation (AF) is significantly more challenging, as a result of arrhythmia perpetuation promoting atrial substrate changes and AF maintenance. We describe a tailored ablation strategy targeting multiple left atrial (LA) sites via a pentaspline pulsed field ablation (PFA) catheter in persistent AF sustained beyond 6 months (PerAF > 6 m) and long-standing persistent AF (LSPAF). The ablation protocol included the following stages: pulmonary vein antral and posterior wall isolation plus anterior roof line ablation (Stage 1); electrogram-guided substrate ablation (Stage 2); atrial tachyarrhythmia regionalization and ablation (Stage 3). Seventy-two [age:68 ± 10years, 61.1%males; AF history: 25 (18-45) months] patients with PerAF > 6 m (52.8%) and LSPAF (47.2%) underwent their first PFA via the FarapulseTM system. LA substrate ablation (Stage 1 and 2) led to AF termination in 95.8% of patients. AF organized into a left-sided atrial flutter (AFlu) in 46 (74.2%) patients. The PFA catheter was used to identify LA sites showing diastolic, low-voltage electrograms and entrainment from its splines was performed to confirm the pacing site was inside the AFlu circuit. Left AFlu termination was achieved in all cases via PFA delivery. Total procedural and LA dwell times were 112 ± 25 min and 59 ± 22 min, respectively. Major complications occurred in 2 (2.8%) patients. Single-procedure success rate was 74.6% after 14.9 ± 2.7 months of follow-up; AF-free survival was 89.2%. In our cohort, PFA-based AF substrate ablation led to AF termination in 95.8% of cases. Very favourable clinical outcomes were observed during >1 year of follow-up.

P-wave terminal force is related to left pulmonary vein reconnection in patients with atrial fibrillation recurrence after pulmonary vein isolation.

In patients with atrial fibrillation (AF) recurrence after pulmonary vein (PV) isolation, noninvasive markers predicting PV reconnection or PV reconnection sites have not been fully elucidated. This study investigated the relationship between the P-wave terminal force in lead V1 (PTFV1) and the PV reconnection or reconnection site in patients with AF recurrence. We retrospectively studied consecutive patients who underwent second AF ablation between April 1, 2018, and June 1, 2023. PTFV1 was investigated before the first AF ablation (pre-ablation PTFV1) and before the second AF ablation (post-ablation PTFV1). In addition, we examined the ratio of the post-ablation to pre-ablation PTFV1 (PTFV1 ratio). These values were compared between patients with and without PV reconnection, with and without left PV (LPV) reconnection, and with and without right PV (RPV) reconnection. The analysis included 56 patients. PTFV1 was reduced because of the first AF ablation. In addition, the values were more decreased in patients without PV reconnection than with PV reconnection. The PTFV1 ratio was significantly smaller in the patients without LPV reconnection than with LPV reconnection; no significant difference was observed between the patients with and without RPV reconnection. Receiver operating characteristic curve analysis showed that a PTFV1 ratio > 0.69 predicted LPV reconnection with 70.0% sensitivity and 66.7% specificity. In conclusion, the PTFV1 ratio may be a noninvasive marker predicting LPV reconnection in patients with AF recurrence.

Animal Experimental Study of Bioabsorbable Left Atrial Appendage Occluder.

Left atrial appendage (LAA) closure can prevent stroke in high-risk patients with atrial fibrillation.A bioabsorbable LAA occluder made of degradable polymer materials, such as polydioxanone (PDO) and poly-L-lactic acid (PLA), and nitinol wire was used. Occluders were successfully implanted in 18 Chinese rural dogs, 2 of which died within 48 hours after operation due to pericardial tamponade and hemorrhage, respectively. Follow-up observation was performed after transcatheter LAA closure. New tissue was found on the surface of the occluder 2 months after operation. No adjacent structures such as the mitral valve and the left superior pulmonary vein were affected by the occluder discs. Hematoxylin and eosin (HE) staining was performed at 3 months after operation, which showed intact intimal structure on the occluder surface, and unabsorbed PDO and PLA were observed. Scanning electron microscopy showed irregular arrangement of endothelial cells. New endothelial tissue was observed to completely cover the occluder at 6 months after operation. Most PDOs were replaced by fibrous connective tissue, and scanning electron microscopy showed regularly arranged endothelial cells. Pathological examination at 12 months showed only a small remnant of PDO. The gross specimens of the liver, spleen, and kidneys and pathological examination did not indicate thromboembolism.The bioabsorbable LAA occluder made of PDO, PLA, and nitinol wire was safe and effective for the occlusion of LAA in dogs. The surface of the occluder was endothelialized half a year after operation. The absorbable materials of the occluder were degraded after 1 year.

Assessing diastolic function using CMR as an alternative to echocardiography: age- and gender-related normal reference values.

Impaired diastolic function is associated with a variety of diseases such as myocarditis or dilated cardiomyopathy. Currently, echocardiography is the standard method for assessing diastolic function. Recently, it has been postulated that cardiovascular magnetic resonance (CMR) is an at least equivalent or superior alternative to echocardiography. To assess CMR-based age- and gender-dependent diastolic functional normal reference values, pulmonary venous and transmitral blood-flow parameters were examined in heart-healthy test persons. Flow-sensitive phase-contrast CMR imaging was performed in the right upper pulmonary vein (RUPV) and at the level of the mitral valve (MV) in 183 healthy subjects (age 10-70years; 97 women, 86 men). The data wasdistributed as evenly as possible across all groups. Strong age-dependence was observed for PV S/D; r = 0.718, p < 0.001 (Pearson product-moment correlation) and for transmitral MV E/A; ρ = -0.736, p < 0.001 (Spearman's Rho correlation). Moderate age-dependence was found for PV slope D-wave; r = 0.394, p < 0.001. Except for MV slope E-wave (male -292cm/s2 interquartile range (IQR) {-338; -243} vs. female -319 ± 82cm/s2; p = 0.047), no gender-related differences were observed. In a subgroup (N = 100), CMR data were compared with echocardiographic data. Strong correlation was found between CMR and echocardiography for PV S/D; r = 0.545, p < 0.001 and MV E/A; ρ = 0.692, p < 0.001. Diastolic functional parameters change with age, while gender-differences are small. CMR and echocardiography showed similar PV S/D and MV E/A ratios, making CMR a promising alternative for assessing diastolic function.

Pulsed Field Ablation of Atrial Fibrillation: A Novel Technology for Safer and Faster Ablation.

Atrial fibrillation (AF), the most common arrhythmia, is associated with increased morbidity, mortality, and healthcare costs. Evidence indicates that rhythm control offers superior cardiovascular outcomes compared to rate control, especially when initiated early after the diagnosis of AF. Catheter ablation remains the single best therapy for AF; however, it is not free from severe complications and only a small percentage of AF patients in the Western world ultimately receive ablation. Ensuring that AF ablation is safe, effective, and efficient is essential to make it accessible to all patients. With the limitations of traditional thermal ablative energies, pulsed field ablation (PFA) has emerged as a novel non-thermal energy source. PFA targets irreversible electroporation of cardiomyocytes to achieve cell death without damaging adjacent structures. Through its capability to create rapid, selective lesions in myocytes, PFA presents a promising alternative, offering enhanced safety, reduced procedural times, and comparable, if not superior, efficacy to thermal energies. The surge of new evidence makes it challenging to stay updated and understand the possibilities and challenges of PFA. This review aims to summarize the most significant advantages of PFA and how this has translated to the clinical arena, where four different catheters have received CE-market approval for AF ablation. Further research is needed to explore whether adding new ablation targets, previously avoided due to risks associated with thermal energies, to pulmonary vein isolation can improve the efficacy of AF ablation. It also remains to see whether a class effect exists or if different PFA technologies can yield distinct clinical outcomes given that the optimization of PFA parameters has largely been empirical.

Quality of Life in Patients with Atrial Fibrillation Undergoing Pulmonary Vein Isolation: Short-Term Follow-Up Study

Background and Objectives: Atrial fibrillation (AF) significantly impacts the quality of life (QoL) of affected individuals. Pulmonary vein isolation (PVI) has emerged as a therapeutic approach to manage AF and improve QoL. This study aimed to assess the QoL in patients with AF undergoing PVI. Methods and Materials: A total of 97 AF patients undergoing PVI (radiofrequency 52.6% (n = 51) and cryoablation 47.4% (n = 46)) at Pauls Stradins Clinical University Hospital were included in this study. QoL was measured using the 36-Item Short-Form Survey (SF-36) before PVI and during a follow-up period of 5.98 ± 1.97 months. Results: This study consisted of 60.8% (n = 59) males, with a mean age of 60.06 ± 11.61 years. A total of 67.0% (n = 65) of patients had paroxysmal AF, and 33.0% (n = 32) had persistent AF. The SF-36 questionnaire revealed major improvements across multiple QoL domains post-PVI, reaching a statistical significance of p &lt; 0.01. Patient factors, such as female gender ([estimate 21.26, 95% CI (7.18, 35.35)], p &lt; 0.01), persistent AF ([estimate 15.49, 95% CI (2.83, 28.15)], p = 0.02), and restored sinus rhythm ([estimate 14.35, 95% CI (1.65, 27.06)], p = 0.03), were associated with significantly improved QoL. Conclusions: PVI in patients with AF positively influences various dimensions of QoL, as evidenced by significant improvement across multiple SF-36 domains. These findings emphasize worsened QoL in patients with AF and the potential benefits of PVI enhancing the overall wellbeing of individuals with AF.

AFTER-CA: Autonomic Function Transformation and Evaluation Following Catheter Ablation in Atrial Fibrillation.

Background: Catheter ablation (CA) is a well-established treatment for atrial fibrillation (AF). However, its effects on autonomic function and underlying mechanisms remain poorly understood. This study investigated autonomic and haemodynamic changes following CA and explored their potential implications for patient outcomes. Methods: Seventy-eight patients with AF underwent CA and were followed up at one, three, and six months. Autonomic function was assessed using a combination of head-up tilt (HUT), handgrip (HG), and deep breathing (DB) manoeuvres along with baroreflex sensitivity (BRS) and baroreflex effectiveness index (BEI) evaluation. Heart rate (HR), blood pressure (BP), and their variability were measured at each time point. Results: Significant autonomic alterations were observed after ablation, particularly at one month, with reductions in parasympathetic tone and baroreflex function. These changes gradually normalised by six months. Both pulmonary vein isolation (PVI) and cryoablation (CryO) had similar effects on autonomic regulation. Improvements in quality of life, measured by the AFEQT scores, were consistent with these physiological changes. Conclusions: CA for AF induces significant time-dependent autonomic and haemodynamic changes with recovery over six months. These findings underscore the need for ongoing monitoring and personalised post-ablation management. Further research is required to explore the mechanisms driving these alterations and their long-term impacts on patient outcomes.

Initial ablation of atrial fibrillation-Is pulmonary vein isolation sufficient? : Pro and contra

Pulmonary vein isolation (PVI) is currently the gold standard for the ablation of atrial fibrillation (AF). Although this procedure shows good success rates, the recurrence rates after PVI alone are significantly higher in advanced AF and in the presence of comorbidities. Therefore, it is important to consider additional arrhythmogenic mechanisms outside the pulmonary veins, depending on the individual case, in order to improve the patients' outcome.

Effectiveness of first-pass pulmonary vein isolation with ablation index-guided ablation compared with very-high-power, short-duration ablation: A retrospective, single-center study.

Effectiveness of first-pass pulmonary vein isolation with ablation index-guided ablation compared with very-high-power, short-duration ablation: A retrospective, single-center study.

Catheter ablation for atrial fibrillation: indications and future perspective.

Recent advances in techniques, technologies and proven superiority over anti-arrhythmic drugs have made catheter ablation the cornerstone of management for atrial fibrillation (AF), which has shown a steady increase in prevalence in the ageing population worldwide. The aim of therapeutic interventions is to achieve stable sinus rhythm that would improve the quality of life and reduce the risk of AF-associated complications. Pulmonary veins (PVs) were first described as the source of initiation of ectopic triggers driving AF, which led to the establishment of PV isolation (PVI) as the most widely practiced procedure to treat AF. Antral PVI is still recognized as the stand-alone ablation strategy for newly diagnosed paroxysmal AF (PAF). However, in non-PAF patients, PVI seems to be inadequate and several adjunctive strategies, including ablation of left atrial posterior wall and non-PV triggers, AF mapping and ablation of rotors and drivers, ethanol infusion of vein of Marshall and renal denervation, etc. have been reported with mixed results. Recent trials have also documented the benefits of early rhythm control in preventing cardiovascular events in addition to slowing the progression of PAF to more persistent forms. Similarly, very late relapse of the arrhythmia after successful PVI has drawn attention to the critical role of non-PV triggers and highlighted their relevance as potential ablation targets during repeat procedures. Ablation technology is also under constant evolution with the introduction of non-thermal energy sources and new tools to create durable lesions. This review summarizes the indications, advancements, and future perspective of AF ablation.

Electrographic flow mapping of atrial fibrillation.

A low ceiling of efficacy exists for the treatment of persistent atrial fibrillation via pulmonary vein isolation without adjunctive ablations, which is likely because they do not target an individual patient's specific underlying disease mechanisms. Electrographic flow (EGF) mapping is the first system that reliably displays wavefront propagation through the atria. It is a promising tool for localizing sources of atrial fibrillation, guiding targeted ablation, and visualizing conduction through the atrial substrate. We describe EGF mapping with emphasis on contemporary studies examining map reproducibility and use cases in the preclinical and clinical environment. Animal experiments demonstrated that maps were interpretable across increasingly complex rhythms with pacing during spontaneously persistent atrial fibrillation reliably simulating EGF sources. The FLOW-AF randomized controlled trial showed that source ablation improved outcomes and that EGF map properties may be used to phenotype patients based on their atrial fibrillation mechanisms and recurrence likelihoods. Targeted ablation strategies balance the risks of insufficiently ablating atrial fibrillation triggers with exacerbating disease through additional scar formation. EGF mapping leverages spatiotemporal relationships in voltage to localize sources and quantify substrate health. Further research is needed to optimize phenotyping and treatment efforts.

Comparative analysis of recurrence predictors and outcomes for atrial tachyarrhythmia following atrial fibrillation ablation: high-power short-duration vs. conventional pulmonary vein isolation

Comparative analysis of recurrence predictors and outcomes for atrial tachyarrhythmia following atrial fibrillation ablation: high-power short-duration vs. conventional pulmonary vein isolation

Unilateral pulmonary vein atresia: Difficulties of radiological diagnosis

Pulmonary vein atresia is a rare congenital abnormality that could manifest in isolation or in association with other congenital abnormalities in the cardiovascular system such as pulmonary vein hypoplasia. Pulmonary vein atresia leads to changes in cardiovascular functioning. This abnormality is often diagnosed in children with recurrent pneumonia and hemoptysis. In adulthood, pulmonary vein atresia is much less common, with clinical symptoms such as dyspnea during physical exercises and hemoptysis. However, some patients are asymptomatic. Owing to the nonspecific imaging findings, lung parenchymal changes are often misdiagnosed as another lung disease, including inflammatory genesis disease. In this article, a case of a young man with asymptomatic unilateral pulmonary vein atresia combined with pulmonary artery hypoplasia and interstitial lung changes in a lung with hypoplasia was presented. These pathologies were first identified in a 21-year-old patient by contrast-enhanced computed tomography.

Standardized Temporary Atrial Epicardial Wire Locations Lead to Enhanced Atrial Signal Identification.

Background: Arrhythmias, common after pediatric cardiac surgery, are associated with increased morbidity and mortality. Atrial epicardial wires (AEW) improve diagnostic accuracy but have variable pacing and sensing properties based on their location. Even so, there are no longitudinal prospective pediatric studies examining ideal placement of AEW. Methods: This multicenter study compared atrial amplitudes, pacing sensitivities and thresholds via AEW placed at Bachmann's Bundle (BB) and the interatrial groove near the right pulmonary veins (IGRPV) versus the surgeons' standard locations. An AtriAmp system was used to obtain an atrial ECG to calculate atrial and ventricular amplitude from atrial electrograms on the bedside monitor. Sensitivities and thresholds via a temporary pacemaker were documented. ANOVA tests with repeated measures and post-hoc pairwise comparisons were performed to compare variables within the first 24-h postoperative hours. Mixed effects linear regression models were employed to examine daily trends. Results: In the first 24-h following cardiac surgery, AEW at BB and IGRPV showed significantly larger atrial amplitudes than the surgeons' standard locations. In addition, there was a negative trend in atrial ECG amplitude in all AEW from postoperative days 0 to 1; however, subsequent days showed a positive mean change in atrial amplitude with largest increase seen at BB. Atrial sensing as measured by the temporary pacemaker had statistically greater atrial signal amplitude from the BB-IGRPV set in both polarities (ie, with the BB as the - or + electrode pair) as compared to the surgeons' standard locations. No difference in atrial thresholds (mA) were noted in the immediate postoperative period or over time, with a relatively low atrial threshold at all sites. Conclusion: Standardization of AEW at Bachmann's Bundle can yield largest atrial amplitudes by atrial ECG and highest atrial sensing parameters without compromising atrial thresholds.

Empirical superior vena cava electrical isolation guided by quantitative ablation index improves outcomes of radiofrequency catheter ablation for paroxysmal atrial fibrillation

BackgroundThe value of empirical superior vena cava isolation (SVCI) following pulmonary vein isolation (PVI) to improve the efficacy of radiofrequency catheter ablation (RFCA) for paroxysmal atrial fibrillation (PAF) remains controversial.ObjectiveTo...

A case of pulmonary vein reconnection after long‐term success of pulmonary vein isolation for atrial fibrillation

A case of pulmonary vein reconnection after long‐term success of pulmonary vein isolation for atrial fibrillation