A new method of a pulmonary vein map to identify a conduction gap on the pulmonary vein antrum ablation line

Abstract

Background: Electrical isolation of the pulmonary veins (PV) is crucial for atrial fibrillation (AF) ablation. Conduction gaps on the circumferential PV antrum ablation (CPVA) line sometimes remain, which are sometimes difficult to identify. Methods and Results: CPVA of the ipsilateral superior and inferior PVs was performed during sinus rhythm or coronary sinus pacing using the NavX system in 22 AF patients, in whom 1 round of CPVA failed to disconnect 26 individual PVs (30%) in 18 patients. In these patients, a local activation map within the CPVA line (PV map) was created by a 20-pole circular mapping catheter with the use of the NavX, with 71±37 sampling points per PV antrum. The conduction gap was defined as a site on the CPVA line, from which the activation proceeded toward the entire PV. The mapped PV antra were comprised of the left superior PV in 11, right superior PV in 10, left inferior PV in 3, right inferior PV in 1 and a left common PV in 1 PV(s). The conduction gaps were identified at 1.4±0.7 sites per PV antrum, with an electrogram amplitude of 0.8±0.7 mV. A point ablation at the gap completely isolated 24 out of 26 PV antra (92%) with 1.9±1.3 applications. Conclusions: The PV map was useful for quickly and accurately identifying the conduction gap(s) after 1 round of CPVA. © All rights are reserved to the Japanese Circulation Society.