Post–pulmonary vein isolation voltage remapping–guided incremental lesions: A feasible strategy to improve long-term outcomes

Figures

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  Figure 1. Study overview: participant flow chart. LVA = low-voltage area; PVI = pulmonary vein isolation; VGA = voltage guided ablation.

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  Figure 2. Post–pulmonary vein isolation remapping–guided incremental lesion strategy: Voltage mapping of a patient in whom we identified incomplete ablation areas (right) with posterior incremental lesion delivery (left).

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  Figure 3. Low-voltage areas and incomplete ablation distribution in the wide-area circumferential ablation. Illustration of the left atrium (LA) from a posterior view. Stars represent the documented location of incomplete ablation in the wide area circumferential ablation. Red indicates the left superior pulmonary vein (LSPV), green the left inferior pulmonary vein (LIPV), orange the right superior pulmonary vein (RSPV), and blue the right inferior pulmonary vein (RIPV). Yellow and purple stars indicate the left and right carinas, respectively. Reprinted with permission from Kanitsoraphan et al.21 CS = coronary sinus; IVC = inferior vena cava; SCV = superior vena cava.

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  Figure 4. Kaplan-Meier survival analysis. Kaplan-Meier curves illustrating recurrence-free survival in the post–pulmonary vein isolation (PVI) remapping group (red line) and in the conventional PVI group (blue line). CI = confidence interval.

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  Figure 5. Subgroup analysis for paroxysmal and persistent atrial fibrillation (AF). Kaplan-Meier curves illustrating recurrence-free survival. Patients with paroxysmal AF (A) and patients with persistent AF (B). The red line indicates the post–pulmonary vein isolation (PVI) remapping group and the blue line indicates in the conventional PVI group.

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  Figure 6. A: Kaplan-Meier (KM) curve for 440 patients who underwent a first radiofrequency pulmonary vein isolation (PVI). B: KM curve for 318 patients with paroxysmal atrial fibrillation who underwent a first radiofrequency PVI. C: KM curve for 122 patients with persistent atrial fibrillation who underwent a first radiofrequency PVI. P values for the log-rank test.