The Study Of Recovery Of Pulmonary Veins Gaps In Second Procedure Of Atrial Fibrillation Recurrence Patients

Objective To observe the pulmonary veins of recovered gaps in second procedure of atrial fibrillation, and locate the distribution of gaps in original ablation line. To compare the differences in the location of gaps between CBA and IRA group, also,comparing the distribution of gaps in patients with PAF and Pe AF.Methods38 patients undergoing second procedures because of atrial fibrillation recurrence from April 2014 to February 2016 in Fujian provincial hospital were included in this study(9female, 29 male), age 30~77 years(60.6±10.5 years), PAF(24 cases) and Pe AF(14cases), CBA group(12 cases) and IRA group(26 cases). A circular mapping catheter was positioned in pulmonary vein to map the gaps. Under the guidance of electroanatomieal mapping system(Ensite NAVX), the gaps were located and ablated.The pulmonary veins of recovered gaps and the distribution of gaps were recorded.Results Catheter radiofrequency ablation was performed successfully in all patients. All of them reached the electrical isolation of pulmonary veins again, which 2 cases(5.3%)continued mitral isthmus ablation, 7 cases(18.4%) tricuspid isthmus ablation, 1 case(2.6%) left atrium linear ablation, 4 cases(10.5%) superior/inferior vena cava electrical isolation, and 2 cases(5.3%) fragmentation potential isolation. Recovered gaps was demonstrated in LSPV with 18 cases(47.4%), LIPV with 14 cases(36.8%), LCPV with1 case(2.6%), RSPV with 20 cases(52.6%), RIPV with 21 cases(55.3%); 13 cases(34.2%) with single pulmonary vein gaps recovered, 15 cases(39.5%) with two, 8 cases(21.1%) with three and 2 cases(5.3%) with four. There was no significant difference between paroxysmal and persistent atrial fibrillation in the site and number of pulmonary veins of recovered gaps. A total of 80 gaps were found in all patients, the right anterior superior segment 4(5.0%), right anterior middle 4(5.0%), right anterior inferior 1(1.3%) and right roof 5(6.3%), right bottom 4(5.0%), right posterior superior3(3.8%), right posterior middle 18(22.5%), right posterior inferior 5(6.3%); left anterior superior segment 4(5.0%), left anterior middle 10(12.5%), left anterior inferior1(1.3%), left roof 4(5.0%), left bottom 7(8.8%), left posterior superior 7(8.8%), left posterior middle 2(2.5%), and left posterior inferior 1(1.3%). There were no significant differences between CBA and IRA group in the distribution of gaps. But we had found a significant difference between PAF and Pe AF group in left posterior superior segment( P<0.05).Conclusion1. Recovery of left atrial-pulmonary vein gaps is the main mechanism of recurrence of atrial fibrillation after CPVA. The recovery of gaps was roughly divided in each pulmonary vein, however, the re-conduction rate of four pulmonary veins was lower,and all are Pe AF.2. Left atrial-pulmonary vein conduction gaps were most commonly situated at the left pulmonary vein anterior middle segment and right pulmonary veins posterior middle segment. There were no significant differences between CBA and IRA group in the distribution of gaps; but a significant difference between PAF and Pe AF group was found in left posterior superior segment.3. Gaps concentrated in the left pulmonary vein anterior middle segment and right pulmonary veins posterior middle segment may related to the complexity of local anatomy, thick myocardial and unsatisfactory catheter postion.