Impact of the pulmonary vein orifice area assessed using intracardiac echocardiography on the outcome of radiofrequency catheter ablation for atrial fibrillation
- 33 Downloads
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.
KeywordsAtrial fibrillation Radiofrequency catheter ablation Intracardiac echocardiography Pulmonary vein isolation
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.
- 2.Pappone C, Rosanio S, Augello G, Gallus G, Vicedomini G, Mazzone P, et al. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol. 2003;42:185–97.CrossRefPubMedGoogle Scholar
- 11.Lickfett L, Kato R, Tandri H, Jayam V, Vasamreddy CR, Dickfeld T, et al. Characterization of a new pulmonary vein variant using magnetic resonance angiography: incidence, imaging, and interventional implications of the “right top pulmonary vein”. J Cardiovasc Electrophysiol. 2004;15:538–43.CrossRefPubMedGoogle Scholar
- 12.Hauser TH, Essebag V, Baldessin F, McClennen S, Yeon SB, Manning WJ, et al. Prognostic value of pulmonary vein size in prediction of atrial fibrillation recurrence after pulmonary vein isolation: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2015;17:49.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Yamamoto T, Yamada T, Yoshida Y, Inden Y, Tsuboi N, Suzuki H, et al. Comparison of the change in the dimension of the pulmonary vein ostia immediately after pulmonary vein isolation for atrial fibrillation-open irrigated-tip catheters versus non-irrigated conventional 4 mm-tip catheters. J Interv Card Electrophysiol. 2014;41:83–90.CrossRefPubMedGoogle Scholar
- 18.Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, Crijns HJ, et al. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace. 2007;9:335–79.CrossRefPubMedGoogle Scholar
- 27.Merchant FM, Levy MR, Iravanian S, EC C, HM K, RL E, et al. Pulmonary vein anatomy assessed by cardiac magnetic resonance imaging in patients undergoing initial atrial fibrillation ablation: implications for novel ablation technologies. J Interv Card Electrophysiol. 2016;46:89–96.CrossRefPubMedGoogle Scholar
- 28.Ouyang F, Antz M, Ernst S, Hachiya H, Mavrakis H, Deger FT, et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation. 2005;111:127–35.CrossRefPubMedGoogle Scholar