Acute electrical isolation is a necessary but insufficient endpoint for achieving durable PV isolation: the importance of closing the visual gap
Key result
Visual gaps in acutely isolated PVs harbor adenosine-provoked dormant conduction in ~29% of pairs.
- n=28
Why the study?
Temporary ablation effects such as oedema may cause reversible pulmonary vein isolation, and the impact of incomplete circumferential ablation lines on conduction properties is unclear.
Does acute electrical isolation with an incomplete circumferential ablation line (visual gap) result in dormant pulmonary vein conduction in patients undergoing AF ablation?
Population
28 patients undergoing ablation for paroxysmal or persistent atrial fibrillation
Comparison
Acute electrical PV isolation with incomplete circumferential ablation line (visual gap) vs complete isolation
Design
Observational study with electrophysiological testing using adenosine and pacing maneuvers
Follow-up
Acute (intraprocedural)
Authors
Discussion
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Member takes
Implication
May warrant adenosine testing of visual gaps during AF ablation; leaves open whether targeted closure improves durable PVI.
Study Design
Type
Observational (n=28)
Structured PICO
Does acute electrical isolation with an incomplete circumferential ablation line (visual gap) result in dormant pulmonary vein conduction in patients undergoing AF ablation?
P
Population
28 patients undergoing ablation for paroxysmal or persistent atrial fibrillation.
E
Exposure
Point-by-point circumferential ablation to achieve acute electrical pulmonary vein (PV) isolation with an intentional incomplete circumferential ablation line ('visual gap')
O
Outcome
Presence of dormant PV conduction assessed with adenosine and pacing manoeuvressurrogate
Acute electrical isolation of pulmonary veins can occur despite incomplete anatomical ablation lines, but these visual gaps frequently harbor dormant conduction, highlighting the need for complete circumferential ablation for durable isolation.
Cite This Study
Miller et al. (2012) conducted an observational in Atrial fibrillation (n=28). Intentional visual gap (ViG) during circumferential ablation was evaluated on Presence of a visual gap (ViG) despite acute electrical isolation. Despite acute electrical isolation, a visual gap remained in 75% of pulmonary vein pairs, with adenosine revealing dormant conduction in 28.6% (12/42) of these acutely isolated pairs.