High density mapping guided partial antral ablation for a pulmonary vein isolation

Abstract The muscular discontinuities at the pulmonary vein (PV)–left atrial (LA) junction are known. The high-density mapping may help to find the muscular discontinuity. This study evaluated the efficacy of a partial antral ablation for a pulmonary vein (PV) isolation using high density (HD) mappi...

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Autores principales:	Jongmin Hwang, Seongwook Han, Chun Hwang, Hyoung-Seob Park, Cheol Hyun Lee, In-Cheol Kim, Yun-Kyeong Cho, Jin Wook Chung, Hyuck-Jun Yoon, Hyungseop Kim, Chang-Wook Nam, Seung-Ho Hur, Jin Young Kim, Yun Seok Kim, Woo Sung Jang
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a1f387e17e8c4d7aac01b1626d9f54bf
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spelling	oai:doaj.org-article:a1f387e17e8c4d7aac01b1626d9f54bf2021-12-02T15:10:34ZHigh density mapping guided partial antral ablation for a pulmonary vein isolation10.1038/s41598-021-96004-42045-2322https://doaj.org/article/a1f387e17e8c4d7aac01b1626d9f54bf2021-08-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-96004-4https://doaj.org/toc/2045-2322Abstract The muscular discontinuities at the pulmonary vein (PV)–left atrial (LA) junction are known. The high-density mapping may help to find the muscular discontinuity. This study evaluated the efficacy of a partial antral ablation for a pulmonary vein (PV) isolation using high density (HD) mapping. A total of 60 drug-refractory atrial fibrillation (AF) patients undergoing catheter ablation were enrolled. The detailed activation mapping of each PV and LA junction was performed using an HD mapping system, and each PV segment’s activation pattern was classified into a “directly-activated from the LA” or “passively-activated from an adjacent PV segment” pattern. The antral ablations were performed at the directly-activated PV segments only when the PV had “passively-activated segments”. If the PV did not contain passively-activated segments, a circumferential antral ablation was performed on those PVs. A “successful partial antral ablation” was designated if the electrical isolation of targeted PV was achieved by ablation at the directly-activated segments only. If the isolation was not achieved even though all directly-activated segments were ablated, a “failed partial antral ablation” was designated, and then a circumferential ablation was performed. Among 240 PVs, passively-activated segments were observed in 140 (58.3%) PVs. Both inferior PVs had more passively-activated segments than superior PVs, and the posteroinferior segments had the highest proportion of passive activation. The overall rate of successful partial antral ablation was 85%. The atrial tachyarrhythmia recurrence was observed in 10 patients (16.7%) at 1-year. HD mapping allowed the evaluation of the detailed activation patterns of the PVs, and passively-activated segments may represent muscular discontinuity. Partial antral ablation of directly-activated antral segments only was feasible and effective for a PVI.Jongmin HwangSeongwook HanChun HwangHyoung-Seob ParkCheol Hyun LeeIn-Cheol KimYun-Kyeong ChoJin Wook ChungHyuck-Jun YoonHyungseop KimChang-Wook NamSeung-Ho HurJin Young KimYun Seok KimWoo Sung JangNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jongmin Hwang Seongwook Han Chun Hwang Hyoung-Seob Park Cheol Hyun Lee In-Cheol Kim Yun-Kyeong Cho Jin Wook Chung Hyuck-Jun Yoon Hyungseop Kim Chang-Wook Nam Seung-Ho Hur Jin Young Kim Yun Seok Kim Woo Sung Jang High density mapping guided partial antral ablation for a pulmonary vein isolation
description	Abstract The muscular discontinuities at the pulmonary vein (PV)–left atrial (LA) junction are known. The high-density mapping may help to find the muscular discontinuity. This study evaluated the efficacy of a partial antral ablation for a pulmonary vein (PV) isolation using high density (HD) mapping. A total of 60 drug-refractory atrial fibrillation (AF) patients undergoing catheter ablation were enrolled. The detailed activation mapping of each PV and LA junction was performed using an HD mapping system, and each PV segment’s activation pattern was classified into a “directly-activated from the LA” or “passively-activated from an adjacent PV segment” pattern. The antral ablations were performed at the directly-activated PV segments only when the PV had “passively-activated segments”. If the PV did not contain passively-activated segments, a circumferential antral ablation was performed on those PVs. A “successful partial antral ablation” was designated if the electrical isolation of targeted PV was achieved by ablation at the directly-activated segments only. If the isolation was not achieved even though all directly-activated segments were ablated, a “failed partial antral ablation” was designated, and then a circumferential ablation was performed. Among 240 PVs, passively-activated segments were observed in 140 (58.3%) PVs. Both inferior PVs had more passively-activated segments than superior PVs, and the posteroinferior segments had the highest proportion of passive activation. The overall rate of successful partial antral ablation was 85%. The atrial tachyarrhythmia recurrence was observed in 10 patients (16.7%) at 1-year. HD mapping allowed the evaluation of the detailed activation patterns of the PVs, and passively-activated segments may represent muscular discontinuity. Partial antral ablation of directly-activated antral segments only was feasible and effective for a PVI.
format	article
author	Jongmin Hwang Seongwook Han Chun Hwang Hyoung-Seob Park Cheol Hyun Lee In-Cheol Kim Yun-Kyeong Cho Jin Wook Chung Hyuck-Jun Yoon Hyungseop Kim Chang-Wook Nam Seung-Ho Hur Jin Young Kim Yun Seok Kim Woo Sung Jang
author_facet	Jongmin Hwang Seongwook Han Chun Hwang Hyoung-Seob Park Cheol Hyun Lee In-Cheol Kim Yun-Kyeong Cho Jin Wook Chung Hyuck-Jun Yoon Hyungseop Kim Chang-Wook Nam Seung-Ho Hur Jin Young Kim Yun Seok Kim Woo Sung Jang
author_sort	Jongmin Hwang
title	High density mapping guided partial antral ablation for a pulmonary vein isolation
title_short	High density mapping guided partial antral ablation for a pulmonary vein isolation
title_full	High density mapping guided partial antral ablation for a pulmonary vein isolation
title_fullStr	High density mapping guided partial antral ablation for a pulmonary vein isolation
title_full_unstemmed	High density mapping guided partial antral ablation for a pulmonary vein isolation
title_sort	high density mapping guided partial antral ablation for a pulmonary vein isolation
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/a1f387e17e8c4d7aac01b1626d9f54bf
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High density mapping guided partial antral ablation for a pulmonary vein isolation

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