Electrical connection between ipsilateral pulmonary veins: prevalence and implications for ablation and adenosine...

Area of Science:

• Electrophysiology
• Cardiac Anatomy
• Interventional Cardiology

Background:

• Anatomical studies reveal shared myocardial fibers between approximately half of ipsilateral pulmonary veins (IPVs).
• Understanding the electrical connections between IPVs is crucial for effective atrial fibrillation (AF) ablation strategies.

Purpose of the Study:

• To assess the prevalence of electrical connections between IPVs.
• To evaluate the impact of antral isolation with or without carina ablation on IPV electrical connection.

Main Methods:

• Thirty patients undergoing AF ablation (14 redo) were included.
• Pulmonary vein isolation (PVI) was performed with or without carina lesions.
• IPV electrical connection was assessed pre- and post-PVI using pacing and recording; adenosine was administered to check for acute reconnection.

Main Results:

• All PVs demonstrated ipsilateral connection before ablation, often via the left atrium.
• Post-PVI, 65.6% of IPVs remained connected without carina ablation versus 17.7% with carina ablation (P = .001).
• Connected IPVs showed uniform responses to adenosine, suggesting a single catheter can assess both veins.

Conclusions:

• Electrical connection between IPVs is consistently present before ablation.
• Antral PVI leaves two-thirds of IPVs connected; carina ablation significantly reduces this.
• Monitoring one IPV is sufficient to confirm electrical status in connected ipsilateral pairs.