Author + information
- Received February 21, 2019
- Revision received May 23, 2019
- Accepted May 24, 2019
- Published online July 15, 2019.
- Raphaël P. Martins, MD, PhD∗ (, )
- Vincent Galand, MD,
- Nathalie Behar, MD,
- Jean-Claude Daubert, MD,
- Philippe Mabo, MD,
- Christophe Leclercq, MD, PhD and
- Dominique Pavin, MD
- ↵∗Address for correspondence:
Dr. Raphaël P. Martins, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France.
• Recurrences of AF after an initial wide antral circumferential ablation are often due to reconnection gaps on previous ablation lines.
• Finding gaps may be simple, but is sometimes challenging since gaps can be difficult to find, resulting in unnecessary radiofrequency delivery.
• Various pacing technique can help to detect residual reconnection gaps.
• High-resolution mapping offers an invaluable possibility to record low amplitude signals along ablation lines.
Ablation of atrial fibrillation (AF) is the cornerstone therapy for patients with symptomatic AF resistant to anti-arrhythmic drugs or as first-line therapy, and is based on permanent pulmonary vein (PV) isolation. The presence of a conduction gap in a wide antral circumferential ablation lesion around PVs is often sufficient to transform an initially successful ablation into a procedural failure, thus necessitating a redo intervention. The strategy during a redo procedure is based on the detection and ablation of the reconnection gap. Finding gaps is often simple, but also sometimes challenging, because gaps may be difficult to detect, resulting in unnecessary radiofrequency delivery. The present review aimed to describe the various techniques published thus far to detect residual reconnections along the encircling ablation lines around PVs, to help electrophysiologists to detect and ablate reconnection gaps.
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 21, 2019.
- Revision received May 23, 2019.
- Accepted May 24, 2019.
- 2019 American College of Cardiology Foundation
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