Circumferential pulmonary vein isolation with a "tricircle" strategy under image integration guidance achieved a 90% success rate in patients with a common ostium of the inferior pulmonary veins.
Observational (n=1,226)
Is a 'tricircle' circumferential pulmonary vein isolation strategy guided by image integration effective in patients with atrial fibrillation and a common ostium of inferior pulmonary veins?
A 'tricircle' circumferential pulmonary vein isolation strategy guided by image integration is highly successful (90%) for treating atrial fibrillation in patients with the rare anatomical variation of a common ostium of inferior pulmonary veins.
BACKGROUND: Common ostium of the inferior pulmonary veins (PVs) is a kind of unusual variation in pulmonary venous drainage to the left atrium (LA), whose feature of anatomy, electrophysiology, and catheter ablation is rarely demonstrated, and the consecutive series of research for catheter ablation of atrial fibrillation (AF) in patients with that anomaly have not been reported. METHODS: A total of 1,226 patients with drug-refractory AF received magnetic resonance angiography (MRA) or multidetector computed tomography (MDCT) scan before ablation. Electrophysiological mapping was used to detect the focal triggers in paroxysmal AF. Basic catheter ablation strategy was circumferential PV isolation with "tricircle" under the guidance of image integration system: two circles surround two superior PVs, and the other surround the common trunk. RESULTS: LA and PVs reconstruction by image integration system showed a common pulmonary venous ostium of the right and left inferior PVs before ablation in 11 patients (0.9%). This anomaly could be classified into two types: type A without a short common trunk of inferior PVs and type B with a short common trunk. Fifty-seven percent paroxysmal AF was revealed focal triggers in the common ostium. The success rate of that strategy was 90%. CONCLUSION: Common ostium of inferior PVs could be classified into two types according to the presence of a short common trunk or not. The common ostium was usually an important triggering focus in paroxysmal AF. Catheter ablation strategy of circumferential PV isolation with "tricircle" under the guidance of image integration system would be a good choice.
Yu et al. (Thu,) conducted a observational in Drug-refractory atrial fibrillation (n=1,226). Circumferential PV isolation with "tricircle" under the guidance of image integration system was evaluated on Success rate of the ablation strategy. Circumferential pulmonary vein isolation with a "tricircle" strategy under image integration guidance achieved a 90% success rate in patients with a common ostium of the inferior pulmonary veins.