scholarly journals Novel Clue to Locate Conduction Gaps in the Pulmonary Vein Isolation Ablation Line

2021 ◽  
Vol 8 ◽  
Author(s):  
Hai-yang Xie ◽  
Xiao-gang Guo ◽  
Jian-du Yang ◽  
Yan-qiao Chen ◽  
Zhong-jing Cao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Validation Cohort ◽  
Far Field ◽  
Prospective Evaluation ◽  
Superior Pulmonary Vein ◽  
Interval Value ◽  
Ablation Line ◽  
Novel Algorithm

Background: Several methods have been reported for locating the conduction gap (CG) in the pulmonary vein isolation (PVI) ablation line. However, the value of the interval between far-field atrial potential (FFP) and pulmonary vein potential (PVP) remains unknown.Methods: Consecutive patients with a CG during observation on the table after PVI were included. The PVP, FFP, and the CG location were evaluated to develop a novel algorithm to identify the CG location in the left superior pulmonary vein. The performance of this novel algorithm was prospectively tested in a validation cohort of consecutive patients undergoing repeat PVI ablation.Results: A total of 116 patients with atrial fibrillation (AF) were recruited, 56 of whom formed the validation cohort. The interval between FFP and PVP of the left superior pulmonary vein was associated with the CG location, and an interval <5 ms predicted the presence of CG in the upper portion of the ostium with a sensitivity of 92.9% and a specificity of 96.9%. In the prospective evaluation, the interval was able to correctly predict the site of CG in 89.6% of cases.Conclusions: The interval between FFP and PVP is a novel and accurate index that can be used to predict the CG location in the left superior pulmonary vein. An far-field atrial potential and pulmonary vein potential (FFP–PVP) interval value of ≥5 ms could be used to exclude a CG in the upper portion of the ostium in the majority of patients undergoing AF ablation.

P1028Incidence and location of residual gaps identified by a high-density grid-style mapping catheter after PVI is confirmed by pacing the ablation lines

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Giuggia ◽  
M Volpicelli ◽  
N Bottoni ◽  
P Gora ◽  
M Mantica
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
De Novo ◽  
Clinical Success ◽  
The United States ◽  
Small Sample ◽  
High Density ◽  
Ablation Line ◽  
Mapping Catheter

Abstract Background  Durable pulmonary vein isolation (PVI) is critical to the clinical success of ablation for treatment of atrial fibrillation (AF). Pacing along the ablation line (often using the ablation catheter), is one technique that is commonly used for confirmation of PVI. While this technique is common in practice, it has not been systematically evaluated against other methods for confirming PVI. A high-density grid-style mapping catheter (HD Grid) enabling simultaneous recording of adjacent bipolar EGMs in two directions (HD Wave) is now available in multiple geographies. The sensitivity of this technology for periprocedural identification of gaps in PVI lines has not previously been compared to the technique of pacing the ablation lines. Purpose  To assess the utility of a high-density grid-style catheter for confirming PVI, and to evaluate sensitivity for identification of gaps relative to a technique of pacing the ablation lines. Methods  Self-reported procedural data was prospectively collected in atrial fibrillation ablation procedures. Cases in which pulmonary vein isolation was confirmed by pacing the ablation line and subsequently assessed with HD Grid were selected for analysis. Techniques for PVI confirmation were analyzed and the incidence and location of residual gaps following PVI confirmation via pacing was quantified. Results  A total of 22 AF ablation procedures (age 60.1 ± 9.0 years, LVEF 59.3 ± 5.7%, CHADS 1.5 ± 1.4, hypertension 45.5%) across 5 centers in Italy and the United States were analyzed. De novo and repeat ablations represented 72.7% and 22.7% of cases, respectively (4.5% not reported). PVI was confirmed by pacing along the ablation line with an average output of 8.8 ± 1.9mV and pulse width of 2.2 ± 0.7ms (10mv at 2ms utilized in 59.1%). Subsequent PVI assessment was performed with HD Grid using the HD Wave configuration in all cases. PVI confirmation techniques included exit block confirmation (90.9%), voltage mapping (59.1%), loss of pace capture along ablation lines (40.9%), entrance block confirmation (18.2%), and activation mapping (4.5%); note: total exceeds 100% as more than one technique may be employed in a single case. The HD Grid identified a total of 30 gaps in 15 (68.2%) patients, which were initially missed by pacing along the ablation lines. No adenosine or isoproterenol use was documented in any case. Conclusion(s): Use of the HD Grid appears to increase substantially, the sensitivity for identifying gaps in PVI lesion sets relative to a technique of pacing the ablation line. Limitations of this analysis include small sample size and workflows which consistently assessed PVI with the HD grid following confirmation of isolation by pacing the ablation lines. Despite these limitations, the high prevalence of residual gaps is quite provocative and may warrant additional study. Abstract Figure.

scholarly journals Cavotricuspid Isthmus Ablation Line Reconnections Are Associated with Clinical and Inducible CTI Flutters in Patients Undergoing Pulmonary Vein Isolation for Atrial Fibrillation

2011 ◽  
Vol 27 (Supplement) ◽  
pp. PE3_043
Author(s):  
William W. B. Chik ◽  
Toon W. Lim ◽  
Choon H. Koay ◽  
Valerie A. See ◽  
Rebecca McCall ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Cavotricuspid Isthmus ◽  
Ablation Line
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