Introduction
Circumferential pulmonary vein isolation (PVI) is an effective therapy
for atrial fibrillation (AF). Recently, the impact of first-pass
isolation has become the focus of research. The success of first-pass
isolation has been reported to result in less AF recurrence and a lower
rate of PV reconnection during the second
procedure.1-2 Advances in catheter technology and
ablation strategies have reduced the residual gaps in isolation lines
and increased the success rate of first-pass
isolation.3 Specifically, 3D mapping systems reduce
interlesion gaps. Moreover, advances in contact-force sensing and
irrigation catheters have reduced transmural gaps.
However, a wide antral approach has been shown to be more effective than
ostial PVI for AF.4 Yet, wide area first-pass
isolation can be difficult and sometimes requires additional carina
ablation, especially in right-sided PV.5-6 The
presence of epicardial connections (ECs) imposes additional difficulty
in PVI.5-10 Barrio-Lopez et al. reported an
association between the presence of ECs and a lower success rate of PVI,
leading to AF
reccurence.7Thus, ECs may be one of the remaining therapeutic targets for successful
first-pass isolation. However, these two studies did not evaluate the
relative locations of the PVI line and ECs, and the effects of the
positional relationship between the EC and right-sided PV anterior
isolation line on the success rate of first-pass PVI remain unclear. The
objective of this study was to examine the importance of designing an
anterior line for right-sided PVI, considering the EC site.