Pulmonary Vein Isolation as an End Point for Left Atrial Circumferential Ablation of Atrial Fibrillation
Kristina Lemola, MD,
Hakan Oral, MD, FACC*,
Aman Chugh, MD,
Burr Hall, MD,
Peter Cheung, MD,
Jihn Han, MD,
Kamala Tamirisa, MD,
Eric Good, DO,
Frank Bogun, MD,
Frank Pelosi, Jr, MD, FACC and
Fred Morady, MD, FACC
Division of Cardiology, University of Michigan, Ann Arbor, Michigan.
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Figure 1 Left atrial (LA) circumferential ablation. Shown is the posteroanterior projection of the LA. Ablation lines encircle the left- and right-sided pulmonary veins (PV), and there are additional ablation lines in the posterior LA and along the mitral isthmus. LI = left inferior; LS = left superior; RI = right inferior; RS = right superior.
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Figure 2 An example of a pulmonary vein (PV) tachycardia. Shown are electrocardiographic leads I and V5, bipolar electrograms recorded with a decapolar ring catheter positioned at the ostium of a left superior PV (L1-2, ..., L10-1), and electrograms recorded within the coronary sinus (CSd, CSp). The mean cycle length of the PV tachycardia was 110 ms, and the cycle length within the CS was 245 ms.
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Figure 3 Prevalence of pulmonary vein (PV) potentials before (open bars) and after (solid bars) left atrial circumferential ablation. Other abbreviations as in Figure 1.
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Figure 4 Effect of left atrial circumferential ablation (LACA) on activation of pulmonary vein (PV) potentials during coronary sinus (CS) pacing. Shown is the shortest stimulus-to-PV potential interval recorded in the same left superior PV before (70 ms) (A) and after LACA (200 ms) (B).
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Figure 5 Freedom from recurrent atrial fibrillation (AF) and number of completely isolated pulmonary veins (PVs). The probability of freedom from recurrent AF after left atrial circumferential ablation was unrelated to the number of isolated PVs. The number of patients is shown within each bar.
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