Why the study?
Intercaval bundles between right PVs and the RA often require additional RF carina ablation to achieve right PV isolation during AF ablation, prompting comparison of high-power short-duration ablation guided by unipolar signal modification versus conventional methods.
Does high-power short-duration ablation guided by unipolar signal modification reduce the need for additional right pulmonary vein carina ablation compared to the conventional method in patients undergoing initial box isolation for atrial fibrillation?
Does high-power short-duration ablation guided by unipolar signal modification reduce the need for additional right pulmonary vein carina ablation compared to the conventional method in patients undergoing initial box isolation for atrial fibrillation?
High-power and short-duration ablation guided by unipolar signal modification may be insufficient for ablating epicardial connections between the right pulmonary vein carina and right atrium, requiring more frequent additional ablation compared to conventional methods.
High-power short-duration ablation with unipolar guidance may increase need for additional right PV carina ablation; hypothesis-generating and requires randomized confirmation.
BACKGROUND: When performing an electrical isolation of ipsilateral pulmonary veins (PVs) for atrial fibrillation, physicians often need additional radiofrequency (RF) ablation in the carina region between the superior and inferior PVs to achieve a right PV isolation because of intercaval bundles between the right PVs and right atrium (RA). We compared the efficacy of a high-power and short-duration ablation guided by unipolar signal modification (UM) with the conventional method (CM) for ablating epicardial connections between the right PV carina and RA. METHODS: The study subjects consisted of patients who underwent an initial box isolation of atrial fibrillation from January 2015 to December 2019 at Nara Medical University Hospital. Among these patients, 94 and 65 patients who met the criteria were assigned to the CM and UM groups, respectively. We retrospectively analyzed the anterior ablation line of the right PV using an electroanatomical mapping system. Patients whose initial ablation line included the right PV carina were excluded. No anatomical factors were associated with the additional right PV carina ablation. CONCLUSIONS: Compared to the CM group, a box isolation was less achievable without RF ablation at the right PV carina in the UM group. We should consider a long-duration ablation for epicardial connections between the right PV carina and RA.
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Yano et al. (2021) studied this question.
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