Acute Epicardial Pulmonary Vein Reconnection: Nondurable Transmural
Lesion or Late Manifestation of Non-preferential Conduction
Abstract
Background Acute pulmonary vein reconnection via epicardial
fibers can be found during observation period after PV isolation, the
characteristics and related factors have not been fully studied.
Objective To investigate the prevalence, locations, electrogram
characteristics and ablation parameters related to acute epicardial
pulmonary vein reconnection (AEPVR). Methods Acute PVR was
monitored during observation period after PV isolation, from which
AEPVRs were mapped and distinguished from endocardial conduction gaps.
The clinical, electrophysiological characteristics and lesion set
parameters were compared between patients with and without PVR. So were
they compared among AEPVR, gap-related reconnection, and epicardial PVR
in repeat procedures. Results 56.1% acute PVR were AEPVR, which
required a longer waiting period ( P<0.001) than
endocardial gap. The majority of AEPVR were connections from the
posterior PV antrum to the left atrial posterior wall, followed by late
manifestation of intercaval bundle conduction from the right anterior
carina to right atrium. AEPVR was similar to epicardial PVR in redo
procedures in distribution and electrogram characteristics. Smaller
atrium ( P<0.001), lower impedance drop (
P=0.039) and ablation index ( P=0.028) on the posterior
wall were independently associated with presence of AEPVR, while lower
inter-lesion distance ( P=0.043) was the only predictor for AEPVR
in acute PVR. An integrated model containing multiple lesion set
parameters had the highest predictive ability for AEPVR in ROC analysis.
Conclusions Epicardial reconduction accounted for the majority of
acute PVR. AEPVR was associated with anatomic characteristics and
multiple ablation-related parameters, which could be explained by
nondurable transmural lesion or late manifestation of non-preferential
conduction.