CHARACTERISTICS OF INTRA-OPERATION RECURRENCE OF ATRIO-VENOUS CONDUCTION DURING CATHETER PULMONARY VEIN ISOLATION IN PATIENTS WITH ATRIAL FIBRILLATION

To assess acute recurrence and concealed conduction in the pulmonary vein (PV) antrum, 134 patients aged 56±8.6 years with paroxysmal and persistent atrial fibrillation (AF) with documented indications to radiofrequency ablation (RFA) were examined. During the operation, the anatomic map of the left atrium (LA) was constructed; radiofrequency applications were made on the perimeter of the PV antrums. Ipsilateral PVs were isolated as a single whole (en bloc). Upon isolating pulmonary veins, the “point of final isolation” (PFI) was marked. In case of development of acute recurrence in PVs, during the observational period (30 min), additional radiofrequency applications were made in the “break” area. After the observational period, the ATP test was carried out. In the case of recording of concealed conduction in PV, additional radiofrequency applications were made in the area of transitory “break”. The duration of the procedure was 123±18 min, of the X-ray exposure (fluoroscopy), 23±6.7 min. In all 134 cases, all PVs were isolated (268 ipsilateral couples). In the left antrum, PFI were located in the left atrium crest in more than in 50% of cases. In the right antrum, PFI were located on the posterior wall and were adjacent to the left atrium “roof’ in more than 60% of cases. In the observational period, acute recurrence was noted in 84 of 134 patients (63%), in total in 94 of 238 couples (35%) of ipsilateral PVs. During the ATP test, in 31 of 134 patients (23%), the concealed conduction into at least one ipsilateral vein was revealed, in total in 33 of 268 couples (12%). Thus, acute recurrence takes place in a considerable number of patients who receive RFA of AF. The location of acute recurrence and concealed conduction is inhomogeneous and is related to the peculiar features of RFA.

atrial fibrillation, radiofrequency catheter ablation, left atrium, pulmonary veins, acute recurrence, observational period, adenosine triphosphate

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