Characteristics of right pulmonary vein with an epicardial connection needing additional carina ablation for isolation

Figures

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  FIGURE 1. Analysis of anatomical characteristics of right pulmonary vein (RPV) based on computed tomography data. (Panel A) shows the RPV bifurcation angle, which was calculated as the angle between the lines which run longitudinally through the center of superior and inferior RPVs in a cross‐sectional plane. (Panel B) shows the area occupation ratio of the carina region to the RPV antrum (ARC), which was calculated as the area ratio of the carina to the RPV antrum. (Panel C) shows the presence of mid RPV, which was defined as a pulmonary vein (PV) for which the ostium originates from the carina region, not from the trunk of each superior or inferior RPV.

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  FIGURE 2. The distribution of gaps above or within 10 mm inside the line after first pass in the groups according to epicardial connection (EC). Although the prevalence of gaps was different in posterior–inferior area (1% in the group without EC vs. 9% in the group with EC, p = .010), that was not different in the remaining areas between the groups.

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  FIGURE 3. Representative cases with small and large right pulmonary vein (RPV) bifurcation angles. The left panel shows a case without epicardial connection (EC) and a small RPV bifurcation angle of 33.2°. The right panel shows a case with EC and a large RPV bifurcation angle of 52.2°.

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  FIGURE 4. Representative cases with small and large area occupation ratios of the carina region to the right pulmonary vein antrum (ARC). The left panel shows a case without epicardial connection (EC) and a small ARC of 28.1%, and the right panel shows a case with EC and a large ARC of 41.1%.

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  FIGURE 5. Results of the detailed right pulmonary vein carina mapping of the representative case with epicardial connection (EC). The left panel shows the activation map, which revealed the earliest activation zone in the carina region in a patient with EC. The center and right panels show the bipolar and unipolar voltage maps, which revealed the high‐voltage zone in the carina region, which overlapped with the earliest activation zone.