Electroanatomic remodeling of the left atrium in patients undergoing repeat pulmonary vein ablation

Mechanistic insights and implications for ablation

Cézar Eumann Mesas, Giuseppe Augello, Christopher Charles Edward Lang, Filippo Gugliotta, Gabriele Vicedomini, Nicoleta Sora, Angelo Amato Vincenzo De Paola, Carlo Pappone

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Introduction: There is limited information describing late changes in the electroanatomic characteristics of the left atrium (LA) associated with recurrence after an anatomical circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF). Methods and Results: Forty-seven patients (57 ± 8 years) undergoing a repeat ablation after CPVA were included. Using an electroanatomic mapping system, we measured the bipolar voltage by averaging points in the pulmonary vein (PV)-LA junction and four other LA sites. Conduction velocity and AF cycle length (AFCL) were also measured and the results are compared with the first procedure. After an initial decrease observed at the end of the first procedure, voltage and conduction velocity returned to intermediate values in all LA sites, with lower voltage at the LIPV antrum (P = 0.004), and lower conduction velocity across the LIPV and RSPV (P <0.001). Conduction gaps were more prevalent at the septal aspect of the right PV encircling lines (85%), between the left atrial appendage (LAA) and the LSPV (70%) and lines at the posterior wall (71%). There was a nonsignificant increase in AFCL, with a more widespread distribution of organized electrograms (32.4% vs 46.6%). Conclusion: Recurrence after CPVA is associated with a reverse process of voltage and conduction velocity increase across ablated areas, especially the PV-LA junction, and is related to the presence of conduction gaps, which are distributed mostly at the septal aspect of the lines encircling the right PVs and at the LAA-LSPV area. Organization of atrial electrograms seen during AF ablation is maintained at a repeat procedure.

Original languageEnglish
Pages (from-to)1279-1285
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume17
Issue number12
DOIs
Publication statusPublished - Dec 2006

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Pulmonary Veins
Heart Atria
Atrial Fibrillation
Atrial Appendage
Cardiac Electrophysiologic Techniques
Recurrence

Keywords

  • Ablation
  • Atrial fibrillation
  • Recurrence
  • Remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Electroanatomic remodeling of the left atrium in patients undergoing repeat pulmonary vein ablation : Mechanistic insights and implications for ablation. / Mesas, Cézar Eumann; Augello, Giuseppe; Edward Lang, Christopher Charles; Gugliotta, Filippo; Vicedomini, Gabriele; Sora, Nicoleta; De Paola, Angelo Amato Vincenzo; Pappone, Carlo.

In: Journal of Cardiovascular Electrophysiology, Vol. 17, No. 12, 12.2006, p. 1279-1285.

Research output: Contribution to journalArticle

Mesas, Cézar Eumann ; Augello, Giuseppe ; Edward Lang, Christopher Charles ; Gugliotta, Filippo ; Vicedomini, Gabriele ; Sora, Nicoleta ; De Paola, Angelo Amato Vincenzo ; Pappone, Carlo. / Electroanatomic remodeling of the left atrium in patients undergoing repeat pulmonary vein ablation : Mechanistic insights and implications for ablation. In: Journal of Cardiovascular Electrophysiology. 2006 ; Vol. 17, No. 12. pp. 1279-1285.
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abstract = "Introduction: There is limited information describing late changes in the electroanatomic characteristics of the left atrium (LA) associated with recurrence after an anatomical circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF). Methods and Results: Forty-seven patients (57 ± 8 years) undergoing a repeat ablation after CPVA were included. Using an electroanatomic mapping system, we measured the bipolar voltage by averaging points in the pulmonary vein (PV)-LA junction and four other LA sites. Conduction velocity and AF cycle length (AFCL) were also measured and the results are compared with the first procedure. After an initial decrease observed at the end of the first procedure, voltage and conduction velocity returned to intermediate values in all LA sites, with lower voltage at the LIPV antrum (P = 0.004), and lower conduction velocity across the LIPV and RSPV (P <0.001). Conduction gaps were more prevalent at the septal aspect of the right PV encircling lines (85{\%}), between the left atrial appendage (LAA) and the LSPV (70{\%}) and lines at the posterior wall (71{\%}). There was a nonsignificant increase in AFCL, with a more widespread distribution of organized electrograms (32.4{\%} vs 46.6{\%}). Conclusion: Recurrence after CPVA is associated with a reverse process of voltage and conduction velocity increase across ablated areas, especially the PV-LA junction, and is related to the presence of conduction gaps, which are distributed mostly at the septal aspect of the lines encircling the right PVs and at the LAA-LSPV area. Organization of atrial electrograms seen during AF ablation is maintained at a repeat procedure.",
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T2 - Mechanistic insights and implications for ablation

AU - Mesas, Cézar Eumann

AU - Augello, Giuseppe

AU - Edward Lang, Christopher Charles

AU - Gugliotta, Filippo

AU - Vicedomini, Gabriele

AU - Sora, Nicoleta

AU - De Paola, Angelo Amato Vincenzo

AU - Pappone, Carlo

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N2 - Introduction: There is limited information describing late changes in the electroanatomic characteristics of the left atrium (LA) associated with recurrence after an anatomical circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF). Methods and Results: Forty-seven patients (57 ± 8 years) undergoing a repeat ablation after CPVA were included. Using an electroanatomic mapping system, we measured the bipolar voltage by averaging points in the pulmonary vein (PV)-LA junction and four other LA sites. Conduction velocity and AF cycle length (AFCL) were also measured and the results are compared with the first procedure. After an initial decrease observed at the end of the first procedure, voltage and conduction velocity returned to intermediate values in all LA sites, with lower voltage at the LIPV antrum (P = 0.004), and lower conduction velocity across the LIPV and RSPV (P <0.001). Conduction gaps were more prevalent at the septal aspect of the right PV encircling lines (85%), between the left atrial appendage (LAA) and the LSPV (70%) and lines at the posterior wall (71%). There was a nonsignificant increase in AFCL, with a more widespread distribution of organized electrograms (32.4% vs 46.6%). Conclusion: Recurrence after CPVA is associated with a reverse process of voltage and conduction velocity increase across ablated areas, especially the PV-LA junction, and is related to the presence of conduction gaps, which are distributed mostly at the septal aspect of the lines encircling the right PVs and at the LAA-LSPV area. Organization of atrial electrograms seen during AF ablation is maintained at a repeat procedure.

AB - Introduction: There is limited information describing late changes in the electroanatomic characteristics of the left atrium (LA) associated with recurrence after an anatomical circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF). Methods and Results: Forty-seven patients (57 ± 8 years) undergoing a repeat ablation after CPVA were included. Using an electroanatomic mapping system, we measured the bipolar voltage by averaging points in the pulmonary vein (PV)-LA junction and four other LA sites. Conduction velocity and AF cycle length (AFCL) were also measured and the results are compared with the first procedure. After an initial decrease observed at the end of the first procedure, voltage and conduction velocity returned to intermediate values in all LA sites, with lower voltage at the LIPV antrum (P = 0.004), and lower conduction velocity across the LIPV and RSPV (P <0.001). Conduction gaps were more prevalent at the septal aspect of the right PV encircling lines (85%), between the left atrial appendage (LAA) and the LSPV (70%) and lines at the posterior wall (71%). There was a nonsignificant increase in AFCL, with a more widespread distribution of organized electrograms (32.4% vs 46.6%). Conclusion: Recurrence after CPVA is associated with a reverse process of voltage and conduction velocity increase across ablated areas, especially the PV-LA junction, and is related to the presence of conduction gaps, which are distributed mostly at the septal aspect of the lines encircling the right PVs and at the LAA-LSPV area. Organization of atrial electrograms seen during AF ablation is maintained at a repeat procedure.

KW - Ablation

KW - Atrial fibrillation

KW - Recurrence

KW - Remodeling

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