Electrophysiological Evaluation of Pulmonary Vein Isolation

Journal of Atrial Fibrillation
Simon Kircher, Philipp Sommer

Abstract

Since the pulmonary veins (PVs) were identified as a major source of AF triggers, ablation strategies targeting the PVs have evolved from focal ablation inside the PVs to wide area circumferential PV isolation (PVI) which at this juncture is the standard approach. Despite the widespread popularity of PVI, a universal definition is lacking. While "entrance block" is a generally accepted endpoint for PVI, the role of "exit block" has yet to be determined. Inexcitability of the circular ablation line has been introduced as a promising additional endpoint for PVI and was associated with an improved clinical outcome in a randomized trial. Correct interpretation of PV electrograms during an ablation procedure is critical in terms of efficacy and safety. A variety of electrophysiological techniques help to correctly differentiate components of complex PV electrograms. Resumption of PV conduction after initially successful PVI leading to AF recurrence remains a major problem and confirmation of bi-directional conduction block does not exclude reversible tissue damage along the ablation line. Prolongation of post-PVI monitoring and application of provocative procedures such as the administration of adenosine after initial PVI to unmask ...Continue Reading

Citations

Sep 30, 2020·Journal of Clinical Medicine·Sahar AvazzadehLeo R Quinlan

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