Clinical implications
In this study, RAPW pacing could detect the EC that can interrupt PV
isolation by antral circumferential ablation, and such an occurrence was
higher in patients with a low EAT volume and in relatively younger
patients. There has been a dramatic improvement in the efficacy of
transmural ablation by using an irrigation catheter, contact force, and
the ablation index/lesion size index.21 With these
technologies, it is presumed that there are only a few cases in which PV
isolation is not achieved because of the inability to achieve
circumferential lesions transmurally, and EC may play a more important
role in the resistance of PV isolation. Therefore, in relatively younger
patients or patients with a small EAT volume, the presence of carina
conductivity should be assessed before AF ablation, as early detection
of carina conduction may help avoid unnecessary additional antral
ablation and collateral damage.