Impact of the pulmonary vein orifice area assessed using intracardiac echocardiography on the outcome of radiofrequency catheter ablation for atrial fibrillation

  • Takashi Nakashima
  • Masanori Kawasaki
  • Hiroyuki Toyoshi
  • Nobuhiro Takasugi
  • Tomoki Kubota
  • Hiromitsu Kanamori
  • Hiroaki Ushikoshi
  • Takuma Aoyama
  • Kazuhiko Nishigaki
  • Shinya Minatoguchi



The purposes of this study were to investigate pulmonary vein cross-sectional orifice area (PV-CSOA) using intracardiac echocardiography (ICE) and to determine its association with atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA).


We studied 77 patients undergoing initial RFCA for AF (55 paroxysmal and 22 persistent AF patients, mean age 61 ± 12 years, 59 men). The PV-CSOA was measured in each patient and expressed as an index divided by the body surface area—left superior (LSPV-CSOA), left inferior (LIPV-CSOA), right superior (RSPV-CSOA), and right inferior (RIPV-CSOA).


After a mean follow-up of 21 ± 14 months, 61 patients maintained sinus rhythm (non-recurrence group) and AF recurred in 16 patients (recurrence group). The LSPV-CSOA index was significantly greater in the recurrence group compared with the non-recurrence group (146 ± 41 vs. 126 ± 30 mm2/m2, p = 0.04). A Cox regression multivariate analysis revealed that the LSPV-CSOA was the independent predictor of AF recurrence (HR 1.02, 95% CI 1.01–1.04, p = 0.01). The LSPV-CSOA cutoff value of 154 mm2/m2 predicts AF recurrence with 50% positive predictive value and 89% negative predictive value.


The present study suggests that ICE can be used as an alternative imaging tools for assessing the PV-CSOA during RFCA and that the LSPV-CSOA index was a useful independent predictor of AF recurrence after RFCA.


Atrial fibrillation Radiofrequency catheter ablation Intracardiac echocardiography Pulmonary vein isolation 


Author contributions

TN designed the study and wrote the manuscript. MK helped to analyze the dates and to draft the manuscript. HT, NT, and TK were the ablation operators and helped to write the manuscript. HK, HU, TA, and KN critically revised the article for important intellectual content. SM gave final approval of the article.

Compliance with ethical standards

This study was approved by the Institutional Review Board of Gifu University. Informed consent was obtained from all patients.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Takashi Nakashima
    • 1
  • Masanori Kawasaki
    • 1
  • Hiroyuki Toyoshi
    • 2
  • Nobuhiro Takasugi
    • 1
  • Tomoki Kubota
    • 1
  • Hiromitsu Kanamori
    • 1
  • Hiroaki Ushikoshi
    • 1
  • Takuma Aoyama
    • 3
  • Kazuhiko Nishigaki
    • 1
  • Shinya Minatoguchi
    • 1
  1. 1.Department of CardiologyGifu University, Graduate School of MedicineGifuJapan
  2. 2.Department of CardiologyChuno Kousei HospitalSekiJapan
  3. 3.Department of CardiologyKizawa Memorial HospitalMinokamoJapan

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