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Wall thickness of the pulmonary vein-left atrial junction rather than electrical information as the major determinant of dormant conduction after contact force-guided pulmonary vein isolation

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Abstract

Purpose

The usefulness of electrogram (EGM)-based information has been reported for assessing lesion transmurality during atrial fibrillation (AF) ablation, but the wall thickness of the pulmonary vein-left atrial (PV-LA) junction has not been considered. We conducted a study to evaluate the relation between PV-LA junction wall thickness and the presence of adenosine triphosphate (ATP)-provoked dormant PV conduction.

Methods

Eighteen AF patients underwent extensive encircling pulmonary vein isolation (EEPVI) with a target CF of >10 g. RF energy was delivered point-by-point at a power setting of 25–30 W for 30 s, and EGM-based information (change in filtered unipolar EGM morphology and bipolar EGM amplitude), decrease in impedance, CF, and CT-based measurement of the PV-LA junction wall thickness were characterized at sites of ATP-provoked dormant conduction.

Results

After EEPVI, ATP-induced dormant conduction was observed at 12 of the 288 PV sites (8 segments per ipsilateral PVs × 2 × 18 patients). Of the 974 ablation points, 72 were located at dormant conduction sites and were strongly associated with thickened PV-LA junction walls (1.02± 0.23 vs. 0.86 ± 0.26 mm, p < 0.0001) and decreased impedance (13.3 ± 6.4 vs. 14.9 ± 7.1 Ω, p = 0.0498) but not with EGM-based information or CF. Multivariate analysis identified the thickened PV-LA junction wall as the strongest predictor of dormant conduction.

Conclusions

A thickened PV-LA junction wall is a robust predictor of ATP-provoked dormant conduction; EGM-based information appears to be insufficient for ensuring adequate lesions during CF-guided EEPVI.

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Acknowledgments

The authors thank Ms. Wendy Alexander-Adams and Mr. George Powell for their encouragement and assistance with the reporting of our findings in English.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan

    Kazuki Iso, Yasuo Okumura, Ichiro Watanabe, Koichi Nagashima, Kazumasa Sonoda, Rikitake Kogawa, Naoko Sasaki, Keiko Takahashi, Sayaka Kurokawa, Toshiko Nakai, Kimie Ohkubo & Atsushi Hirayama

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  1. Kazuki Iso
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  2. Yasuo Okumura
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Correspondence to Yasuo Okumura.

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The study was supported by departmental resources only.

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Iso, K., Okumura, Y., Watanabe, I. et al. Wall thickness of the pulmonary vein-left atrial junction rather than electrical information as the major determinant of dormant conduction after contact force-guided pulmonary vein isolation. J Interv Card Electrophysiol 46, 325–333 (2016). https://doi.org/10.1007/s10840-016-0147-0

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  • DOI: https://doi.org/10.1007/s10840-016-0147-0

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