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Erschienen in: Journal of Interventional Cardiac Electrophysiology 3/2016

14.07.2016

Predictors of chronic pulmonary vein reconnections after contact force-guided ablation: importance of completing electrical isolation with circumferential lines and creating sufficient ablation lesion densities

verfasst von: Kohki Nakamura, Shigeto Naito, Takehito Sasaki, Kentaro Minami, Yutaka Take, Satoru Shimizu, Yoshiaki Yamaguchi, Toshiaki Yano, Michiharu Senga, Eiji Yamashita, Yoshinao Sugai, Koji Kumagai, Nobusada Funabashi, Shigeru Oshima

Erschienen in: Journal of Interventional Cardiac Electrophysiology | Ausgabe 3/2016

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Abstract

Purpose

We aimed to identify the predictors of chronic pulmonary vein reconnections (CPVRs) after contact force (CF)-guided circumferential PV isolation (CPVI) of atrial fibrillation (AF).

Methods

Forty-nine consecutive patients undergoing second ablation procedures for recurrent AF after CF-guided ablation were retrospectively studied. The CPVI was performed by point-by-point ablation with a target CF of 15–20 g. The incidence of CPVRs was evaluated along the right- and left-sided anterior and posterior CPVI regions (Ant-RPVs, Post-RPVs, Ant-LPVs, and Post-LPVs).

Results

CPVRs were observed in 30.6, 22.4, 20.4, and 32.7 % of patients along the Ant-RPVs, Post-RPVs, Ant-LPVs, and Post-LPVs, respectively (P = 0.436). In the multivariate logistic analyses, completing a left atrium-PV conduction block with touch-up ablation inside the initially estimated CPVI lines (Ant-RPVs, Post-RPVs, Ant-LPVs, Post-LPVs; odds ratio [OR] 5.747, 15.000, 207.619, 7.940; P = 0.032, 0.004, 0.034, 0.021) and region length (Post-LPVs; OR 3.183, P = 0.027) were positive predictors of CPVRs, while the mean CF (Ant-RPVs; OR 0.861, P = 0.045) and number of radiofrequency applications per unit length (Ant-LPVs, Post-LPVs; OR 0.038, 0.122; P = 0.034, 0.029) were negative predictors. At optimal cutoffs of 5.8 cm for the region length, 14.2 g for the mean CF, and 1.97/cm (Ant-LPVs) and 2.01/cm (Post-LPVs) for the radiofrequency application density, the sensitivity and specificity were 93.8 and 63.6 %, 60.0 and 76.5 %, 90.0 and 64.1 %, and 75.0 and 63.6 %, respectively.

Conclusions

Completing PVI with circumferential lines without touch-up ablation and creating a sufficient density of radiofrequency ablation lesions on the lines with a sufficient CF may be necessary to prevent CPVRs after a CF-guided CPVI.
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Metadaten
Titel
Predictors of chronic pulmonary vein reconnections after contact force-guided ablation: importance of completing electrical isolation with circumferential lines and creating sufficient ablation lesion densities
verfasst von
Kohki Nakamura
Shigeto Naito
Takehito Sasaki
Kentaro Minami
Yutaka Take
Satoru Shimizu
Yoshiaki Yamaguchi
Toshiaki Yano
Michiharu Senga
Eiji Yamashita
Yoshinao Sugai
Koji Kumagai
Nobusada Funabashi
Shigeru Oshima
Publikationsdatum
14.07.2016
Verlag
Springer US
Erschienen in
Journal of Interventional Cardiac Electrophysiology / Ausgabe 3/2016
Print ISSN: 1383-875X
Elektronische ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-016-0164-z

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