Importance of the relative epicardial connection locations and
right-sided pulmonary vein isolation line for successful pulmonary vein
isolation
Abstract
Background: The presence of an epicardial connection (EC)
decreases the success rate of pulmonary vein isolation (PVI); however,
the effect of designing isolation lines has not been evaluated.
Objective: We sought to clarify the effects of designing an
anterior line for right-sided PVI considering the presence and location
of the EC. Methods: Seventy-four consecutive patients who
underwent initial catheter ablation for atrial fibrillation were
retrospectively included in this study. The presence of the EC was
determined by the left atrial (LA) activation map during right atrial
pacing, and patients were divided into EC-positive (n=23, 31%) and
EC-negative (n=51, 69%) groups. EC-positive patients were further
subdivided based on the EC location: on-the-line group, (EC on the PVI
line, n=11); inside-line group (EC on the pulmonary vein [PV] side,
n=10); and outside-line group (EC on the LA side, n=2). The PVI
parameters were compared among the three groups. Results: The
success rates of the first-pass isolation were comparable between the
EC-negative and EC-positive groups (70.6% vs. 60.9%, ns), but the
success rate was significantly higher in the on-the-line group than in
the inside-line group (91% vs. 20%, p=0.002). First-pass isolation was
successful in both patients in the outside-line group. Additional carina
ablation was required only in the inside-line group.
Conclusions: The association between the EC site and the
right-sided PV anterior isolation line affected the success rate of
first-pass isolation. For successful right-sided PVI, it is important to
consider the EC site when designing the PVI line.