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Blocking the Pulmonary Vein to Left Atrium Conduction in Addition to the Entrance Block Enhances Clinical Efficacy in Atrial Fibrillation Ablation
Author(s) -
CHEN SONGWEN,
MENG WEIDONG,
SHENG HE DING,
CHEN GANG,
ZHANG FENG,
YAN YIWEN,
ZHUGE YING,
LIU SHAOWEN
Publication year - 2012
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2012.03343.x
Subject(s) - medicine , pulmonary vein , atrial fibrillation , cardiology , ablation , left atrium , catheter ablation , anesthesia
Background:The unidirectional pulmonary vein (PV) to left atrium (LA) conduction after achieving PV entrance block has not been evaluated.Methods:Circumferential PV isolation was performed in 573 consecutive patients with atrial fibrillation (AF). The unidirectional PV to LA conduction and its influence on clinical outcomes were evaluated.Results:A total of 341 ipsilateral PVs (29.7%) with spontaneous activities (SAs) were documented in 231 patients (40.3%). The unidirectional PV to LA conduction was confirmed in 11 ipsilateral PVs (3.2%) of 11 patients (4.8%). Patients were classified to three groups: Group A (had unidirectional PV to LA conduction during SAs), Group B (with SAs but without PV to LA conduction), and Group C (without SAs). During a 30‐minute observation, the reconnection incidence was higher in Group A (45.4%) than in Group B (13.9%, P = 0.042) and Group C (11.5%, P = 0.018). The reconnection time was shorter in Group A (10.8 ± 9.8 minutes) than that in Group B (20.7 ± 8.0 minutes, P = 0.037) and Group C (21.2 ± 8.2 minutes, P = 0.022). All 11 PVs were successfully isolated and bidirectional block was achieved.Conclusion:Unidirectional entrance block with SAs in PVs may not be a good indication of complete PV isolation. Bidirectional block of the PV‐LA junction can reduce the acute PV reconnection and may reduce the chronic AF recurrence in patients undergoing circumferential PV isolation.(PACE 2012; 1–8)