Evidence for longitudinal and transverse fiber conduction in human pulmonary veins: relevance for catheter ablation.

BACKGROUND: Segmental ostial ablation of the pulmonary veins (PVs) allows for successful control of paroxysmal atrial fibrillation in many patients. We hypothesized that mapping of the left atrial-PV junction with a 64-electrode basket catheter would allow characterization of conduction patterns that would identify sites where ablation is required to electrically isolate the PV.

METHODS AND RESULTS: A 64-electrode basket catheter was used to map the PVs of 50 patients undergoing PV isolation procedures for the treatment of atrial fibrillation. Activation along each spline was classified as reflecting either longitudinal, transverse, or no activation. A longitudinal activation pattern recorded along a spline during sinus rhythm in right-sided PV and during CS pacing in left-sided PV before the delivery of any RF energy application had a sensitivity and specificity for a required ostial ablation site of 83% and 82%, respectively. When longitudinal activation along the spline was present during preablation recordings in both sinus rhythm and CS pacing, the sensitivity and specificity were 92% and 90%, respectively. A longitudinal activation pattern after the first RF application that produced a change in PV activation sequence had a sensitivity and specificity for sites where further ablation was required of 91% and 94%, respectively.

CONCLUSIONS: Mapping of PV activation with a 64-electrode basket catheter allows characterization of conduction patterns that predict requirement for ablation. The presence of a longitudinal activation pattern is a strong predictor of ostial sites where ablative energy is required to electrically isolate the PV.