Pulmonary vein antrum not always coaxial to the pulmonary vein - A dimensional pitfall to the circumferential isolation technique

Abstract

Background: The dimensions and electrophysiological characteristics of the antral region of human pulmonary veins (PVs) were investigated. Methods and Results: Fifty-five consecutive patients with symptomatic paroxysmal atrial fibrillation underwent PV isolation targeting the PV antrum potentials with a 31 mm multielectrode basket catheter (MBC). The most distal and proximal electrode pairs along the MBC spline where radiofrequency ablation was carried out were identified and the longitudinal distance between those ablation sites (Ld) was measured. When the Ld was ≥6mm, the PV antrum was defined as noncoaxial. In 56% of the left superior PVs, 42% of the right superior PVs, 63% of the left inferior PVs and 56% of the right inferior PVs, a noncoaxial PV antrum was identified. In each PV, the radiofrequency ablation delivery duration and energy to complete the PV antrum isolation were significantly larger in the PVs with a noncoaxial PV antrum than in those with a coaxial PV antrum. Conclusion: The PV antrum is noncoaxial to the PV in >50% of the PVs, a feature that may increase the complexity of the circumferential isolation technique.