The incidence and clinical significance of non-isolation of the pulmonary vein carina after encircling ipsilateral pulmonary veins isolation for paroxysmal atrial fibrillation: A pitfall of the double-Lasso technique

Masateru Takigawa, Takumi Yamada, Yukihiko Yoshida, Kiyotake Ishikawa, Yutaka Aoyama, Takashi Yamamoto, Natsuo Inoue, Yasushi Tatematsu, Mamoru Nanasato, Kazuo Kato, Naoya Tsuboi, Haruo Hirayama

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

AimsEncircling ipsilateral pulmonary veins (PVs) isolation (EIPVsI) with the double-Lasso technique has proven to be effective to cure atrial fibrillation (AF). However, in this technique, PV mapping with circular catheters may miss a non-isolation of the PV carina. The purpose of this study was to reveal the incidence and clinical significance of a non-isolation of the PV carina after EIPVsI.Methods and resultsWe studied 81 consecutive paroxysmal AF patients (age 61 ± 12 years, 56 men), in whom EIPVsI was successfully performed in one encircling line with the endpoint of the demonstration of bidirectional conduction block between the PVs and left atrium (LA) with the double-Lasso technique. After a successful EIPVsI, pacing from the PV carina was performed and it captured the LA in 17 (21.0%) patients. During a mean follow-up period of 19 ± 13 months, AF recurred in 13 (16.0%) patients. A multivariate Cox proportional analysis revealed that a non-isolation of the PV carina after the EIPVsI was a significant predictor (hazard ratio = 3.91, 95% confidence interval = 1.13-14.16, P = 0.03) of AF recurrence. ConclusionsPulmonary vein mapping with the double-Lasso technique did miss the non-isolation of the PV carina after a successful EIPVsI, which was an independent predictor of AF recurrence after the EIPVsI. Pacing from the PV carina may be required to confirm the electrical isolation of the PV carina after EIPVsI with the double-Lasso technique.

Original languageEnglish (US)
Pages (from-to)33-40
Number of pages8
JournalEuropace
Volume15
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

Keywords

  • Atrial fibrillation
  • Carina
  • Conduction
  • Isolation
  • Pulmonary vein
  • Recurrence

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