Key result
Reconnected segments of the pulmonary vein antrum showed a significantly higher average atrial wall thickness grade than non-reconnected segments (2.7 vs 2.2, P < 0.01) in patients with recurrent AF.
Why the study?
Pulmonary vein reconnection is the major cause of recurrence after pulmonary vein isolation for atrial fibrillation, and thicker myocardium may be associated with reconnection.
Does increased atrial wall thickness correlate with pulmonary vein reconnection in patients with recurrent atrial fibrillation after catheter ablation?
Observational (n=79)
No
Does increased atrial wall thickness correlate with pulmonary vein reconnection in patients with recurrent atrial fibrillation after catheter ablation?
Absolute Event Rate: 2.7% vs 2.2%
p-value: p=<0.01
Reconnected segments of the pulmonary vein antrum have thicker myocardium than non-reconnected segments, suggesting that 3D wall thickness mapping could guide customized ablation to reduce recurrence.
Higher atrial wall thickness was associated with PV reconnection in recurrent AF; hypothesis-generating for thickness-guided ablation strategies.
Background The major cause of recurrence after pulmonary vein (PV) isolation for atrial fibrillation (AF) is PV reconnection, and thicker wall could be associated with reconnection. Objectives This study aimed to evaluate the wall thickness of the PV antrum in reconnection sites using a three-dimensional (3D) wall thickness map. Methods A total of 91 patients who underwent a second ablation procedure due to AF recurrence were evaluated. The locations of the PV reconnection sites were confirmed in electroanatomical maps. A 3D atrial wall thickness (AWT) map was created using computed tomography scan data. The AWT values of the ablation lines of the index procedure were graded in each segment of the PV antrum: grade 1, 0.5 < AWT ≤ 1.0 mm; grade 2, 1.0 < AWT ≤ 1.5 mm; grade 3, 1.5 < AWT ≤ 2.0 mm; grade 4, 2.0 < AWT ≤ 2.5 mm; grade 5, AWT > 2.5 mm. Results A total of 281 PV reconnection sites among 1256 segments of the PV antrum in 79 patients were detected. The average AWT grades were 2.7 ± 1.0 and 2.2 ± 1.0 in the reconnected and non-reconnected segments, respectively ( P < 0.01). Higher AWT grades were observed in the reconnected superior segments of the left superior PV, carina and inferior segments of the left inferior PV, superior and posterior segments of the right superior PV, and posterior and inferior segments of the right inferior PV. Conclusion The reconnected segments of the PV antrum showed thicker myocardium than the non-reconnected ones in patients with recurrent AF after catheter ablation. A wall thickness map for PV isolation could be considered for customized ablation in order to reduce PV reconnection.
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Oh et al. (2021) conducted an observational in Atrial fibrillation recurrence (n=79). Reconnected pulmonary vein segments vs. Non-reconnected pulmonary vein segments was evaluated on Average atrial wall thickness (AWT) grade (p=<0.01). Reconnected segments of the pulmonary vein antrum showed a significantly higher average atrial wall thickness grade than non-reconnected segments (2.7 vs 2.2, P < 0.01) in patients with recurrent AF.
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