Relationship between atrial scar on cardiac magnetic resonance and pulmonary vein reconnection after catheter ablation for paroxysmal atrial fibrillation.

Pulmonary vein (PV) reconnection is frequent in patients showing atrial fibrillation (AF) recurrence after PV isolation (PVI). Its detection with cardiac magnetic resonance (CMR) may help predict outcome and guide redo procedures. We assessed the relationship between scar on CMR and PV reconnection after catheter ablation for paroxysmal AF. Fifty-one patients with paroxysmal AF underwent CMR before PVI using either a conventional single-electrode catheter (N = 28) or a circular multielectrode catheter (N = 23). At 3 months, a second CMR study was performed, followed by a systematic electrophysiological procedure to look for PV reconnection, regardless of AF recurrence. Preablation fibrosis and postablation scar were quantified and mapped from late gadolinium-enhanced CMR. CMR results were compared to the distribution and extent of PV reconnection. CMR and electrophysiological findings were compared between catheter types. Three months after successful PVI, scar gaps were found in 39 (76%) patients, and 78 (39%) veins. Electrical PV reconnection was detected in 45 (88%) patients, and 99 (50%) veins. The extent of PV reconnection related closely to the number of gaps (R = 0.55; P < .001), and to scar burden (R = -0.63; P < .001). However, the agreement was only fair for the localization of PV reconnection (k = 0.37; P < .001), scar gaps particularly lacking sensitivity in areas of pre-existing fibrosis. The circular catheter was associated with shorter procedures (P < .001), more scar (P = .01), less gaps (P = .01), and less reconnected veins (P = .03). PV reconnection is extremely frequent after PVI. CMR scar imaging accurately predicts its extent, but poorly predicts its location. Multielectrode circular catheters induce more complete ablation.

Jefairi NA ，Camaioni C ，Sridi S ，Cheniti G ，Takigawa M ，Nivet H ，Denis A ，Derval N ，Mathilde Merle ，Laurent F ，Montaudon M ，Sacher F ，Hocini M ，Haissaguerre M ，Jais P ，Cochet H ... -  《-》

Pulmonary vein reconnection and arrhythmia progression after antral linear catheter ablation of paroxysmal and persistent atrial fibrillation.

Wasmer K ，Dechering DG ，Köbe J ，Mönnig G ，Pott C ，Frommeyer G ，Lange PS ，Kochhäuser S ，Eckardt L ... -  《-》

Comparison of pulmonary vein reconnection patterns after multielectrode phased radiofrequency- and cryoballoon ablation of atrial fibrillation.

Wieczorek M ，Sassani K ，Hoeltgen R 《BMC Cardiovascular Disorders》

Magnetic Resonance Imaging-Guided Fibrosis Ablation for the Treatment of Atrial Fibrillation: The ALICIA Trial.

Bisbal F ，Benito E ，Teis A ，Alarcón F ，Sarrias A ，Caixal G ，Villuendas R ，Garre P ，Soto N ，Cozzari J ，Guasch E ，Juncà G ，Prat-Gonzalez S ，Perea RJ ，Bazán V ，Tolosana JM ，Arbelo E ，Bayés-Genís A ，Mont L ... -  《-》

A RAndomized Trial to compare the acute reconnection after pulmonary vein ISolation with Laser-BalloON versus radiofrequency Ablation: RATISBONA trial.

Dormant conduction and acute reconnection in the pulmonary veins (PV) during a PV isolation can be detected by performing an adenosine provocation test (APT). Visually guided laser balloon ablation (VGLB) creates deep transmural lesions, thus causing less acute reconnection. This study compared the acute PV reconnection rate after isolation with VGLB or with RF using an APT. Patients with paroxysmal AF were randomized to PVI with the VGLB or RF ablation. Each PV underwent an APT at least 20 minutes after successful isolation with injection of 18 mg adenosine. Primary endpoint was the difference between the two ablation methods regarding acute PV reconnection rate detected with APT. A total of 50 patients were randomized into the study (25 VGLB). The basic characteristics and mean procedure time were not different between the two groups. Note that 96% of the 97 targeted PVs in the VGLB group and 98% of the 96 targeted PVs in the RF group could be isolated (P  =  0.41). APT was performed at similar times (after 28 minutes in VGLB-arm vs. after 31.5 minutes in RF-arm; P  =  0.12). Significantly less PVs were reconnected during APT in the VGLB group than in the RF group (10 PV [10.8%] vs. 29 PV [30.9%]; P  =  0.001). The acute PV reconnection rate is significantly less after PVI with VGBL than with RF. The clinical significance of this apparently better procedural efficiency of the VGBL ablation should be assessed with new randomized studies looking at AF recurrence.

Ücer E ，Janeczko Y ，Seegers J ，Fredersdorf S ，Friemel S ，Poschenrieder F ，Maier LS ，Jungbauer CG ... -  《-》