An Epicardial Connection With a Unidirectional Conduction Property From the Left Atrium to Pulmonary Vein

Niiyama, Daichi; Tsumagari, Yasuaki; Uehara, Yoshiko; Baba, Masakazu; Hasebe, Hideyuki; Yoshida, Kentaro

doi:10.1016/j.jaccas.2022.01.011

Cited by 8 publications

(15 citation statements)

References 8 publications

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“…Third, there are some types of ECs with bidirectional conduction between RA and PV, and unidirectional between RA and PV. 27,28 However, the definition of EC in the present study could detect only the ECs…”

Section: Study Limitationsmentioning

confidence: 74%

Characteristics of right pulmonary vein with an epicardial connection needing additional carina ablation for isolation

Nehashi,

Kaneshiro,

Nodera

et al. 2023

Journal of Arrhythmia

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BackgroundThis study thought to elucidate the anatomical features that can predict an epicardial connection (EC) between the right pulmonary vein (RPV) and right atrium.MethodsWe retrospectively analyzed 251 consecutive patients undergoing initial radiofrequency pulmonary vein isolation. We defined EC as present when RPV could not be isolated with circumferential ablation and additional ablation for the conduction gap if needed, and RPV isolation could be achieved by ablation for the earliest activation site >10 mm inside the initial ablation line. Using computed tomography data, we evaluated the RPV bifurcation angle, and the area occupation ratio of the carina region to the RPV antrum (ARC) for predicting EC. In subjects with EC undergoing RPV activation mapping after circumferential ablation, the correlation between conduction delay and bipolar/unipolar potential voltage in the carina region was investigated.ResultsThere were ECs in 45 out of 251 patients (17.9%). The RPV bifurcation angle (47.7° vs. 38.8°, p < .001) and ARC (37.2% vs. 29.7%, p < .001) were significantly greater in the EC (+) group. Multivariate logistic regression analysis revealed that RPV bifurcation angle (odds ratio [OR]: 1.994, p = .002) and ARC (OR: 3.490, p = .013) were independent predictors of EC. In nine patients with EC undergoing carina region mapping, the unipolar potential voltage was correlated with conduction delay in RPV with EC (R = −0.401, p < .001).ConclusionAnatomical features suggesting a wider RPV carina region could predict the presence of EC, and potential with high voltage could be helpful for detecting EC connection sites.

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Section: Study Limitationsmentioning

confidence: 74%

Characteristics of right pulmonary vein with an epicardial connection needing additional carina ablation for isolation

Nehashi,

Kaneshiro,

Nodera

et al. 2023

Journal of Arrhythmia

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“…Further, a previous report revealed that connections located on the LAPW might be associated with the septopulmonary bundle, 18 supporting our finding of the location of ECs on the LAPW. Finally, a recent comprehensive study 10 and case report 11 demonstrated that ECs involving the left-sided PVs were associated with not only the LA, but also the CS or Marshall bundle. The findings in those reports 10, 11 may support our findings that the rate of conduction of ECs from the left PV was also dominant in the CS.…”

Section: Patient Characteristicsmentioning

confidence: 96%

“…The ECs were defined as the existence of RPs during sinus rhythm or atrial pacing (earliest activation sites), and AF within the encircled PV regions, which were located at a distance exceeding at least 5 mm from complete conventional PVAI lines (Figure 1A,B,F,H). 10,11 Evaluation of ECs Inside the Conventional PVAI Lines After completion of the conventional PVAI, during sinus rhythm or CS pacing, the conduction from the atrium to the RPs inside the conventional PVAI lines (entrance conduction) was detected in detail using the HDM catheter with the EnSite TM system. If any RPs were detected (Figure 1A,B,F,H), 5-10 V pacing from the ablation catheter on the RPs was performed in order to confirm where the RPs connected to the atrium (ECs) (exit conduction), such as the coronary sinus (CS) (Figure 1C,J), high right atrium (HRA) (Figure 1G,K), and His-bundle (His) (Figure 1I,L).…”

Section: Definition Of Ecsmentioning

confidence: 99%

“…When AF continued even after cardioversion was performed and the sites where the ECs originated from could not be confirmed, it was defined as unknown. When there were RPs in the PVs, but pacing could not capture them and they could not be conducted to the atrium (unidirectional conduction from the atrium to the PV), 11 it was defined as none. Then, radiofrequency energy was delivered until non-capture by pacing at 5-10 V from the ablation catheter occurred (Figure 1D).…”

Section: Definition Of Ecsmentioning

confidence: 99%

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Epicardial Connections After a Conventional Pulmonary Vein Antrum Isolation in Patients With Atrial Fibrillation

Nyuta

Takemoto

Sakai

et al. 2022

Circ J

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wave front propagation, especially in low voltage zones. By performing HDM mapping inside the PVAI lines after conventional encirclement lesions, we hoped to identify any RPs associated with ECs inside our PVAI lines. Thus, the purpose of this study was to determine the prevalence and number of ECs inside the PVAI lines after a conventional PVAI, and the effect of an EC ablation on the outcomes in patients with non-valvular paroxysmal (pAF), persistent (persAF), and long-lasting AF (LLAF). Methods Baseline Clinical Characteristics of the Patient GroupsThe present study was approved by the institutional review committee and ethics review board of our hospital, the Ethical Review Board of Steel Memorial Yawata Hospital. The procedures were followed in accordance with the Declaration of Helsinki and the ethical standards of the responsible committee on human experimentation. Moreover, we enrolled this study in an international registry of P ulmonary vein (PV) antrum isolation (PVAI) with radiofrequency catheter ablation (RFCA) has proven to be a useful strategy for atrial fibrillation patients (AF) worldwide. 1 To prevent initiating and maintaining AF, a complete PVAI should be a target of the AF treatment. 1 However, in spite of establishing complete PVAI lines, we rarely experience and encounter remaining potentials (RPs) inside our PVAI lines detected by high-density mapping (HDM). Then, when we perform pacing from the ablation catheter on the RPs inside our PVAI lines, we confirm that the pacing can capture RPs and conduct to the atrium. This finding indicates the existence of epicardial connection(s) (ECs) from inside the PVAI lines to the atrium after establishing complete conventional PVAI lines. The recent Intellamap Orion 2 (Boston Scientific Corporation, Marlborough, MA, USA) and Advisor TM HD Grid 3 (Abbott, Plymouth, MN, USA) advanced catheter technologies, which are directional HDM catheters, can not only identify low voltages and small local electrical signals, but also more importantly can capture the direction of the

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“… 4 Recent studies have demonstrated that the presence of epicardial connections (ECs) 5 involving the pulmonary veins (PVs) is one of the mechanisms for failure in achieving a complete PVAI. 6 , 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

A case report of an important role of epicardial connections in producing spontaneous pulmonary vein activity and initiating and maintaining atrial fibrillation

Yagyu

Takemoto

Fujiwara

et al. 2022

HeartRhythm Case Reports

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An Epicardial Connection With a Unidirectional Conduction Property From the Left Atrium to Pulmonary Vein

Cited by 8 publications

References 8 publications

Characteristics of right pulmonary vein with an epicardial connection needing additional carina ablation for isolation

Characteristics of right pulmonary vein with an epicardial connection needing additional carina ablation for isolation

Epicardial Connections After a Conventional Pulmonary Vein Antrum Isolation in Patients With Atrial Fibrillation

A case report of an important role of epicardial connections in producing spontaneous pulmonary vein activity and initiating and maintaining atrial fibrillation

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