Clinical and electrophysiological significance of residual unipolar voltage after performing pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Figures

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  FIGURE 1. Comparison of presence or absence of pulmonary vein potential on unipolar voltage map after confirming pulmonary vein isolation on bipolar voltage map. The bipolar/unipolar voltage discordant group (Bi−/Uni+ group) was defined as the residual unipolar voltage at the PV‐LA junction site where cryo‐balloon ablation was applied. After cryo‐balloon ablation, the residual potential continued from the PV to the LA (case A). The bipolar/unipolar voltage concordant group (Bi−/Uni− group) was defined as no residual unipolar voltage at the PV‐LA junction site where cryo‐balloon ablation was applied. The PV‐LA junction was completely isolated by both bipolar and unipolar voltage mapping (case B). Actual bipolar/unipolar voltage amplitudes and waveforms at certain points in the pulmonary veins have been shown to the right‐hand side of each figure. The top row shows the bipolar voltage and below, two rows show the unipolar voltages. Unipolar voltage map was depicted using the OCTARAY™ mapping catheter with TRUEref™ technology, and bipolar voltage map was depicted between two adjacent electrodes of the OCTARAY™ mapping catheter. Bi, bipolar; LIPV, left inferior pulmonary vein; LSPV, left…

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  FIGURE 2. Study enrollment. During study periods, 169 patients who underwent AF ablation at Tottori University Hospital were reviewed. One hundred twelve patients were excluded due to the exclusion criteria as shown above. As a result, 57 patients were included in this study. Twenty‐two patients were in the “Bi−/Uni+ group,” and 35 patients were in the “Bi−/Uni− group.” AF, atrial fibrillation; PVI, pulmonary vein isolation; RF, radio frequency.

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  FIGURE 3. Comparison of CT findings with or without residual unipolar voltage. LAWT and EAT volume were significantly greater in patients with Bi−/Uni+ group than those with Bi−/Uni− group (2.04 ± 0.23 mm vs. 1.83 ± 0.21, p = .001 and 14.1 ± 7.9 vs. 9.3 ± 5.6, 26 p = .007). EAT, epicardial adipose tissue; EATV, epicardial adipose tissue volume; LA, left atrium; LAWT, left atrial wall thickness; PA, pulmonary artery; PVI, pulmonary vein isolation; RA, right atrium.