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(Circulation. 2002;105:2998.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Electrical Connections Between Pulmonary Veins

Implication for Ostial Ablation of Pulmonary Veins in Patients With Paroxysmal Atrial Fibrillation

Atsushi Takahashi, MD; Yoshito Iesaka, MD; Yoshihide Takahashi, MD; Ryoko Takahashi, MD; Kenzaburo Kobayashi, MD; Katsumasa Takagi, MD; Osamu Kuboyama, MD; Takeo Nishimori, MD; Hidenobu Takei, MD; Hiroshi Amemiya, MD; Hideomi Fujiwara, MD; Masayasu Hiraoka, MD

From the Cardiovascular Center (A.T., Y.I., Y.T., R.T., K.K., K.T., O.K., T.N., H.T., H.A., H.F.), Tsuchiura Kyodo Hospital, and Department of Cardiovascular Disease (M.H.), Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.

Correspondence to Atsushi Takahashi, MD, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7, Manabeshin-machi, Tsuchiura-shi, Ibaraki-ken, Japan. E-mail atsushija{at}aol.com

Background— Electrical disconnection of the myocardial extensions into arrhythmogenic pulmonary veins (PVs) is recognized as a curative technique for paroxysmal atrial fibrillation (AF). However, the presence of electrical connections between the PVs, which may make achievement of PV disconnection difficult, has not been systematically evaluated.

Methods and Results— Forty-nine consecutive patients with drug-resistant AF underwent ostial radiofrequency (RF) catheter ablation of arrhythmogenic PVs with foci triggering AF. Pacing from inside the targeted PV was performed after each RF delivery to identify the left atrial exit site of the residual venoatrial conduction. Successful PV disconnection was defined as achieving elimination of the PV potentials during sinus rhythm or left atrial pacing, and the loss of left atrial conduction during intra-PV pacing. A total of 112 arrhythmogenic PVs were identified. PV disconnection was achieved with 10±6.1 minutes of RF delivery to the ostia of 101 targeted PVs. In 7 left superior (LS) PVs from 7 patients (14%), the earliest atrial activity was recorded from the left inferior (LI) PV ostium during intra-LSPV pacing after 11±4.7 minutes of RF delivery to the LSPV ostium. Disconnection of these LSPVs was achieved by LIPV disconnection. In the remaining 4 PVs from 4 patients, PV disconnection could not be achieved.

Conclusions— Fourteen percent of the patients had electrical connections between contiguous PVs. In these patients, ostial ablation of an untargeted PV was required for successful targeted PV disconnection.

Key Words: fibrillation • catheter ablation • veins • atrium

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