Epicardial connections were identified in 20% of patients undergoing pulmonary vein isolation and were associated with a higher rate of early recurrence of conduction (29% vs 11%; P=0.01).
Observational (n=100)
Absolute Event Rate: 29% vs 11%
p-value: p=0.01
UNLABELLED: INTRODUCTION: Some observations support the existence of epicardial connections (ECs) between ipsilateral pulmonary veins (vein to vein ECs VVECs), and we have observed venoatrial ECs inserted at distance from the pulmonary vein ostium (vein to atrium ECs VAECs). Our aim was to determine the prevalence of ECs and their relevance for pulmonary vein isolation. METHODS AND RESULTS: We studied 100 consecutive patients with drug-refractory atrial fibrillation who underwent ostial pulmonary vein isolation by cooled radiofrequency catheter ablation. A VVEC was identified if pulmonary vein pacing activated the ipsilateral vein before the atrium, requiring ablation of both venous ostia to isolate either pulmonary vein. A VAEC was identified if pacing produced atrial breakthrough located at distance from the venous ostium, requiring extraostial ablation to isolate the pulmonary vein. Patients with ECs (20%) were younger (P = 0.02) and had a higher prevalence of structural heart disease (P = 0.01) than patients without ECs. VVECs and VAECs were identified in 32 pulmonary veins (10%) and VAECs in 10 veins (3%). Veins with ECs had a higher rate of early recurrence of conduction following isolation (29% vs 11%; P = 0.01). CONCLUSION: Twenty percent of patients with atrial fibrillation had ECs resistant to ostial ablation in one or more pulmonary veins. Isolating veins with ECs may require a different ablation approach. These connections are associated with an increased rate of early recurrence of conduction. (J Cardiovasc Electrophysiol, Vol. 22, pp. 149-159, February 2011).
Pérez‐Castellano et al. (Mon,) conducted a observational in drug-refractory atrial fibrillation (n=100). Ostial pulmonary vein isolation by cooled radiofrequency catheter ablation vs. Patients without epicardial connections was evaluated on Early recurrence of conduction following isolation (p=0.01). Epicardial connections were identified in 20% of patients undergoing pulmonary vein isolation and were associated with a higher rate of early recurrence of conduction (29% vs 11%; P=0.01).