Why the study?
Epicardial connections inside pulmonary vein antrum isolation lines occur in about 10% of AF patients and may cause failure to achieve complete isolation and subsequent AF recurrence.
Ablation of epicardial connections inside pulmonary vein antrum isolation lines may be necessary to achieve complete isolation and prevent atrial fibrillation recurrence.
Aims: Recent reports have demonstrated that ∼10% of patients with atrial fibrillation (AF) have epicardial connections (ECs) inside the pulmonary vein (PV) antrum isolation (AI) (PVAI) lines, which could be a possible mechanism of failure to achieve a complete PVAI, thus contributing to AF recurrence. Case summary: We present an 80-year-old female case with consistently continuing AF associated with ECs. Epicardial connections involving the PVs were detected in the left and right superior PVs after the completion of the PVAI. The AF steadily terminated after the ablation of those ECs. She has remained well without any AF or symptoms for 2 years post-ablation. Discussion: Those ECs might have played a possible important role in initiating and maintaining the AF. The mechanism(s) of the ECs may be a cornerstone of the failure to achieve a complete PVAI contributing to AF recurrence. Ablation of the EC(s) in addition to the PVAI may be better able to achieve the completion of the PVAI. Thus, physicians should be aware of the possibility of the presence of EC(s) when performing ablation of AF, even though complete PVAI lines have been achieved.
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Fujiwara et al. (2023) studied this question.
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