Large Right Pulmonary Vein Is a Predictor of Atrial Fibrillation Recurrence after Pulmonary Vein Isolation in Patients with Persistent Atrial Fibrillation

Abstract

Pulmonary vein isolation PVI is an effective treatment for atrial brillation AF. However, outcomes differ between paroxysmal AF and persistent AF. We analyzed the predictors of recurrence by examining the recurrence group after ablation. Of 372 consecutive patients with AF who underwent PVI between June 2016 and December 2018, we evaluated 250 patients age, 67 12 y, 65 men whose left atrium LA was constructed using the PENTARAY catheter BioSense Webster, Los Angeles, CA , a multipolar electrode catheter with a novel shape and excellent mapping capability. We measured the LA total volume LATV , right pulmonary vein antrum volume RPAV , left PV antrum volume LPAV , LA central volume LACV , and LA bipolar voltage. Of the 250 patients, 78 had persistent AF recurrence, 20 and 172 had paroxysmal AF recurrence, 16. In all patients, LATV, LACV, RPAV, and LPAV were signi cantly larger in patients with persistent AF than those with paroxysmal AF. The mean LA bipolar voltage in patients with persistent AF was signi cantly lower than those with paroxysmal AF. In cases of persistent AF, RPAV was signi cantly larger in the recurrence group than that in the non-recurrence group 15.9 4.8 vs 13.4 5.4 ml ; P 0.05. In cases of paroxysmal AF, there were no differences in any volume between the recurrence and non-recurrence groups. In conclusion, larger right PV is a predictor of AF recurrence after PVI in patients with persistent AF. The right PV is close to the atrial septum and the septopulmonary bundle, and the expansion of RPAV re ects the disruption of these structures, which may be involved in this result.