Key result
Pacing from the distal coronary sinus and high right atrium significantly prolonged the interval between near-field potentials and far-field signals in left pulmonary veins and SVC (P<0.01).
Why the study?
Does pacing from the distal coronary sinus and high right atrium improve the discrimination of thoracic vein potentials from far-field signals compared to sinus rhythm in patients undergoing AF ablation?
Observational (n=100)
Does pacing from the distal coronary sinus and high right atrium improve the discrimination of thoracic vein potentials from far-field signals compared to sinus rhythm in patients undergoing AF ablation?
Pacing from the distal coronary sinus and high right atrium facilitates the discrimination of ipsilateral left pulmonary vein and superior vena cava potentials, respectively, aiding in successful electrical isolation during AF ablation.
May aid discrimination of left PV and SVC potentials during AF ablation; leaves open whether it improves isolation success.
BACKGROUND: Although electrical thoracic vein (TV) isolation is an established strategy during atrial fibrillation (AF) ablation, discriminating TV potentials from far-field signals is critical for the achievement. METHODS AND RESULTS: One hundred consecutive drug-refractory symptomatic paroxysmal AF patients who underwent AF catheter ablation were included. All patients underwent circumferential pulmonary vein (PV) isolation during distal coronary sinus (CS) pacing with a cycle length of 600 ms. A superior vena cava (SVC) isolation was added during high right atrial (HRA) pacing with the same cycle length in 79 patients in whom SVC potentials were identified. The interval between the near-field PV potentials and far-field atrial signals significantly prolonged more during distal CS pacing than sinus rhythm (SR) in the left superior (26.0 [18.5-32.8] ms to 36.0 [24.3-55.5] ms, P < 0.01) and left inferior PVs (21.0 [14.0-30.0] ms to 40.0 [23.0-56.0] ms, P < 0.01), but not in the right superior (34.0 [20.0-40.0] ms to 23.0 [18.0-36.0] ms, P = 0.13) and right inferior PVs (22.0 [16.0-28.0] ms to 25.0 [18.0-38.0] ms, P = 0.05). The interval between the SVC potentials and far-field atrial signals significantly prolonged more during HRA pacing than SR (20.0 [0-32.0] ms to 34.0 [24.0-46.0] ms, P < 0.01). Electrical isolation was successfully achieved in all TVs without any complications except for transient right phrenic nerve palsy in two patients. CONCLUSIONS: Discrimination of ipsilateral left PVs and SVC potentials is facilitated by pacing from the distal CS and HRA, respectively. Better recognition of TV potentials would help to achieve electrical isolation.
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Masuda et al. (2014) conducted an observational in drug-refractory symptomatic paroxysmal atrial fibrillation (n=100). Distal coronary sinus (CS) and high right atrial (HRA) pacing vs. Sinus rhythm was evaluated on Interval between near-field potentials and far-field atrial signals. Pacing from the distal coronary sinus and high right atrium significantly prolonged the interval between near-field potentials and far-field signals in left pulmonary veins and SVC (P<0.01).
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