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Incidence and pattern of conduction gaps after pulmonary vein isolation with the endoscopic ablation system

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Abstract

Purpose

Durable pulmonary vein isolation (PVI) is the goal of atrial fibrillation (AF) ablation. The endoscopic ablation system (EAS) is associated with a high rate of persistent PVI. The aim of this study was to analyze the incidence and pattern of conduction gaps in patients with arrhythmia recurrence after an EAS-guided PVI.

Methods

Repeat ablations after an EAS-guided PVI were analyzed. After PV angiograms, PV reconnection was assessed. Radiofrequency ablation was delivered at the earliest pulmonary vein (PV) activation site (gap) with the goal of PV re-isolation.

First, the incidence of reconnected PVs per patient was assessed. Second, the gap pattern according to the individual PV quadrant was analyzed.

Results

Fifty-nine out of 373 (16%) patients underwent a second procedure after index EAS. PV reconnection was observed in 71/230 (31%) PVs without statistically significant differences between individual PVs. A higher incidence of gaps was found for right PVs (49 vs. 27; p 0.0006). The carina between the superior and inferior PV presented a low incidence of gaps (18 vs. 56, p < 0.0001). Gaps were also predominant at the AS segment of the RSPV (11 gaps).

No predictors of reconnection were found, except the higher total amount of application in the reconnected right inferior PV (26.03 ± 1.30 vs. 32.04 ± 2.89; p 0.0396).

Conclusion

EAS-guided PVI results in a 72% durable PVI rate in patients with AF recurrences without difference between individual PVs. More of the gap was found in the right PVs especially in the anterosuperior segment of the RSPV.

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Funding

Stefano Bordignon, Boris Schmidt, and Julian KR Chun received speaking honoraria from CardioFocus. Fabrizio Bologna received financial support from CardioFocus for presenting the abstract.

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Authors and Affiliations

  1. Cardioangiologisches Centrum Bethanien (CCB), Wilhelm Epstein-Str. 4, 60431, Frankfurt am Main, Germany

    Fabrizio Bologna, Stefano Bordignon, Laura Perrotta, Daniela Dugo, Takaiko Nagase, Shaojie Chen, Julian KR Chun & Boris Schmidt

  2. Dipartimento di Cardiologia, Policlinico Universitario di Padova, Padova, Italy

    Manuel De Lazzari

Authors
  1. Fabrizio Bologna
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  2. Stefano Bordignon
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  3. Laura Perrotta
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  4. Daniela Dugo
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  5. Takaiko Nagase
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  6. Shaojie Chen
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  7. Manuel De Lazzari
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  8. Julian KR Chun
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  9. Boris Schmidt
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Correspondence to Boris Schmidt.

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Bologna, F., Bordignon, S., Perrotta, L. et al. Incidence and pattern of conduction gaps after pulmonary vein isolation with the endoscopic ablation system. J Interv Card Electrophysiol 57, 465–471 (2020). https://doi.org/10.1007/s10840-019-00556-5

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