The Timing and Frequency of Pulmonary Veins Unexcitability Relative to Completion of a Wide Area Circumferential Ablation Line for Pulmonary Vein Isolation.

JACC. Clinical Electrophysiology
Samuel H BaldingerGregory F Michaud

Abstract

This study sought to assess loss of pulmonary vein (PV) excitability to pacing relative to the development of entrance block and the anatomic completion of the circumferential radiofrequency ablation (RFA) line. During encircling RFA for PV isolation (PVI), entrance block develops before anatomic completion of encirclement (early) in some patients. We hypothesized that early entrance block may be associated with loss of PV excitability to pacing. In 30 patients undergoing PV isolation (age 61 ± 10 years, 21 men), excitability to pacing was assessed at predefined PV sites when entrance block developed and after completion of the RFA line. Of 60 PV pairs, 37 developed entrance block early, with a gap ≥10 mm in the RFA line. In only 35% of PV pairs in this subgroup, both PV sleeves captured, and all of the capturing PV pairs showed exit block (no conduction from PV to atrium) despite the presence of an excitable gap. In the remaining 23 PV pairs, entrance block did not occur until encircling RFA was anatomically complete. In 83% of these PV pairs, both sleeves captured with exit block (p < 0.001 compared with early block PVs). The majority of PV pairs develops entrance and exit block before complete anatomic encircling by RFA lesi...Continue Reading

References

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Citations

May 11, 2016·Circulation. Arrhythmia and Electrophysiology·Saurabh Kumar, Gregory F Michaud
Sep 20, 2018·Journal of Cardiovascular Electrophysiology·Gareth WynnSimon Modi
Jan 5, 2019·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Yuji WakamatsuYasuo Okumura
Apr 4, 2019·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Rajesh MalikTina D Hunter
Dec 20, 2019·Pacing and Clinical Electrophysiology : PACE·Deepak SalujaJames Coromilas

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