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Impact of the pulmonary vein orifice area assessed using intracardiac echocardiography on the outcome of radiofrequency catheter ablation for atrial fibrillation

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Abstract

Purpose

The purposes of this study were to investigate pulmonary vein cross-sectional orifice area (PV-CSOA) using intracardiac echocardiography (ICE) and to determine its association with atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA).

Methods

We studied 77 patients undergoing initial RFCA for AF (55 paroxysmal and 22 persistent AF patients, mean age 61 ± 12 years, 59 men). The PV-CSOA was measured in each patient and expressed as an index divided by the body surface area—left superior (LSPV-CSOA), left inferior (LIPV-CSOA), right superior (RSPV-CSOA), and right inferior (RIPV-CSOA).

Results

After a mean follow-up of 21 ± 14 months, 61 patients maintained sinus rhythm (non-recurrence group) and AF recurred in 16 patients (recurrence group). The LSPV-CSOA index was significantly greater in the recurrence group compared with the non-recurrence group (146 ± 41 vs. 126 ± 30 mm2/m2, p = 0.04). A Cox regression multivariate analysis revealed that the LSPV-CSOA was the independent predictor of AF recurrence (HR 1.02, 95% CI 1.01–1.04, p = 0.01). The LSPV-CSOA cutoff value of 154 mm2/m2 predicts AF recurrence with 50% positive predictive value and 89% negative predictive value.

Conclusions

The present study suggests that ICE can be used as an alternative imaging tools for assessing the PV-CSOA during RFCA and that the LSPV-CSOA index was a useful independent predictor of AF recurrence after RFCA.

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Author information

Authors and Affiliations

  1. Department of Cardiology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan

    Takashi Nakashima, Masanori Kawasaki, Nobuhiro Takasugi, Tomoki Kubota, Hiromitsu Kanamori, Hiroaki Ushikoshi, Kazuhiko Nishigaki & Shinya Minatoguchi

  2. Department of Cardiology, Chuno Kousei Hospital, 5-1 Wakakusadori, Seki, 501-3802, Japan

    Hiroyuki Toyoshi

  3. Department of Cardiology, Kizawa Memorial Hospital, 590 Kobichoshimokobi, Minokamo, 505-8503, Japan

    Takuma Aoyama

Authors
  1. Takashi Nakashima
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  2. Masanori Kawasaki
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  3. Hiroyuki Toyoshi
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  4. Nobuhiro Takasugi
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  5. Tomoki Kubota
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  7. Hiroaki Ushikoshi
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  8. Takuma Aoyama
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  9. Kazuhiko Nishigaki
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  10. Shinya Minatoguchi
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Contributions

TN designed the study and wrote the manuscript. MK helped to analyze the dates and to draft the manuscript. HT, NT, and TK were the ablation operators and helped to write the manuscript. HK, HU, TA, and KN critically revised the article for important intellectual content. SM gave final approval of the article.

Corresponding author

Correspondence to Takashi Nakashima.

Ethics declarations

This study was approved by the Institutional Review Board of Gifu University. Informed consent was obtained from all patients.

Conflict of interest

The authors declare that they have no conflict of interest.

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Nakashima, T., Kawasaki, M., Toyoshi, H. et al. Impact of the pulmonary vein orifice area assessed using intracardiac echocardiography on the outcome of radiofrequency catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 51, 133–142 (2018). https://doi.org/10.1007/s10840-018-0324-4

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  • DOI: https://doi.org/10.1007/s10840-018-0324-4

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