Pacing Clin Electrophysiol. 2026 Jun 7. doi: 10.1111/pace.70309. Online ahead of print.
ABSTRACT
BACKGROUND: Previous studies have demonstrated electrical connections between ipsilateral pulmonary veins (PVs). This study aimed to characterize the electrophysiological features of right middle pulmonary vein (RMPV) originating from right superior pulmonary vein (RSPV).
METHODS: We prospectively enrolled patients with atrial fibrillation (AF) with an identifiable RMPV on pre-procedural cardiac computed tomography angiography (CTA) and in whom a multipolar mapping catheter could be advanced into the RMPV. Cardiac CTA was used to assess left atrial and PV anatomy, including ostial diameter, area and ovality index. The RMPV was defined as an inferiorly directed branch arising from the ostium-proximal segment of the RSPV, within 1 cm from the ostium RESULTS: A total of 118 patients were included (mean age 63.9 years, 63.6% male). The mean RMPV ostial area was 0.69 ± 0.41 cm2, with maximum and minimum diameters of 0.83 ± 0.21 cm and 0.63 ± 0.17 cm, respectively. The mean ovality index was 1.35 ± 0.27 for RMPV. AF triggers originating from the RMPV were identified in 3 patients (2.5%). During circumferential pulmonary vein isolation (CPVI), RMPV potentials were eliminated in 99 patients (83.9%), concurrently with disappearance of RSPV potentials. In the remaining 19 patients, RMPV potentials persisted after CPVI and required additional carina ablation to achieve isolation. After a mean follow-up of 41 months, 96 patients remained free from atrial tachyarrhythmia recurrence after the index procedure.
CONCLUSIONS: RMPV potentials predominantly originate from the RSPV and can usually be eliminated during CPVI. However, additional carina ablation is required in a subset of patients to achieve RMPV isolation.
PMID:42252501 | DOI:10.1111/pace.70309