Detection of Epicardial Connection Through Intercaval Bundle Involving Right Pulmonary Veins After Ipsilateral Circumferential Ablation by Intra-Atrial Activation Sequence Pacing From the Right Pulmonary Vein

• Published in: Journal of the American Heart Association 2024-05, Vol.13 (9), p.e034004-e034004
• Main Authors: Chikata, Akio, Kato, Takeshi, Usuda, Kazuo, Fujita, Shuhei, Usuda, Keisuke, Kanatani, Mao, Maruyama, Michiro, Otowa, Kan-Ichi, Kusayama, Takashi, Tsuda, Toyonobu, Hayashi, Kenshi, Takamura, Masayuki
• Format: Article
• Language: English
• Subjects: Action Potentials; Aged; atrial activation sequence; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Cardiac Pacing, Artificial - methods; Catheter Ablation - methods; Electrophysiologic Techniques, Cardiac; Female; Heart Atria - physiopathology; Heart Atria - surgery; Heart Conduction System - physiopathology; Heart Rate - physiology; Humans; intercaval epicardial connection; Male; Middle Aged; Original Research; Pericardium - physiopathology; Pericardium - surgery; Pulmonary Veins - physiopathology; Pulmonary Veins - surgery; Retrospective Studies; right pulmonary vein; Treatment Outcome
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.123.034004

An epicardial connection (EC) through the intercaval bundle (EC-ICB) between the right pulmonary vein (RPV) and right atrium (RA) is one of the reasons for the need for carina ablation for PV isolation and may reduce the acute and chronic success of PV isolation. We evaluated the intra-atrial activation sequence during RPV pacing after failure of ipsilateral RPV isolation and sought to identify specific conduction patterns in the presence of EC-ICB. This study included 223 consecutive patients who underwent initial catheter ablation of atrial fibrillation. If the RPV was not isolated using circumferential ablation or reconnected during the waiting period, an exit map was created during mid-RPV carina pacing. If the earliest site on the exit map was the RA, the patient was classified into the EC-ICB group. The exit map, intra-atrial activation sequence, and RPV-high RA time were evaluated. First-pass isolation of the RPV was not achieved in 36 patients (16.1%), and 22 patients (9.9%) showed reconnection. Twelve and 28 patients were classified into the EC-ICB and non-EC-ICB groups, respectively, after excluding those with multiple ablation lesion sets or incomplete mapping. The intra-atrial activation sequence showed different patterns between the 2 groups. The RPV-high RA time was significantly shorter in the EC-ICB than in the non-EC-ICB group (69.2±15.2 versus 148.6±51.2 ms;