Study of epicardial electrical conduction in patients with atrial fibrillation no achieve the endpoin after circumferential pulmonary vein ablation

ZHANG Yi; LIU Hao

doi:10.3969/j.issn.1002-266X.2014.32.004

Abstract：Objective To observe the characteristic of the epicardial electrical conduction in patients with atrial fibril-lation no achieve the endpoint after circumferential pulmonary vein ablation, and to discuss its significance.Methods 54 patients with atrial fibrillation underwent circumferential pulmonary vein ablation were included in the study.The patients no achieve the endpoint after circumferential pulmonary vein ablation were consolidated the ablation line, paced and mapped in the left atrial appendage ( LAA) and left superior pulmonary vein ( LSPV) , also collected the data of computer digital tomography ( CT) of heart.Results Though the pulmonary vein potential ( PVP) loss while the accomplishment of circumferential pulmonary vein ablation for left pulmonary vein ( LPV) , a sharp and delay recurrent PVP could be recorded in LSPV while verification after ablation in 5 patients.It was confirmed to be a epicardial electrical conduction through the LAA and LSPV, by electrophysiologic study.It was a delayed, slow bidirectional conduction, and just appeared after the pulmonary vein antrum isolation.2 cases might be finally blocked by ablation in posterior wall of LAA or anterior wall of depths of LSPV.CT of heart showed that the space was narrow between the LAA and the LSPV, and the LAA-LSPV con-nections could be seen.Conclusions The epicardial electrical conduction between the posterior wall of LAA and the ante-rior wall of depths of LSPV would just appear after the circumferential pulmonary vein isolation, that the pulmonary vein an-trum was isolation, but didn`t achieve the endpoint of ablation.The success rate of ablation was affected by the electrical conduction.The cardiac CT can showed the imaging foundation of it.