Can pulmonary vein antrum be defined by electrophysiological mapping?

Atrial fibrillation (AF) is the most common sustained arrhythmia, and treatments with anti-arrhythmia drugs (AADs) have been frustrating. Limitations of AADs prompted the development of percutaneous catheter ablation. In contrast to AADs, percutaneous catheter ablation offers the possibility of a lasting cure. The successful cure of AF by percutaneous catheter ablation comes from a widespread recognize that pulmonary vein antrum (PVA) plays an important role in the genesis and maintenance of AF, and circular ablation along the PVA can eliminate majority of AF. PVA is comprised of pulmonary vein-left atrium junctions. However, during ablation procedure, definition of PVA solely depends on angiography, and it is largely experience-dependent and there is a great deal of variation involved. Our study in patients with AF found that a unique potential with double deflections could be documented along PVA, but it cannot be recorded at PV side or LA side. Thus, we propose that documentation of PVA potentials can be used as a landmark to define PVA. Unlike angiography, documentation of PVA potentials can be objectively carried out by different operators, and the variations due to experience can be avoided.