Significance of Local Coronary Artery Flow as a Complete Block Line at the Mitral Isthmus in Patients with Atrial Fibrillation

概要

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Background: It is sometimes tough to create a complete Mitral isthmus (MI) block line, and the cooling effect because of the local coronary flow (LCF) may prevent the creation of a successful MI block line. Methods and Results: This study enrolled 81 AF patients in whom the creation of MI block line was attempted. An LCF across the MI block line was observed in 43/81 patients (53%), and bidirectional MI block was successfully accomplished in 53 of 81 (65%) patients. The ratio of a successful MI block line was significantly lower in the patients with an LCF than in those without (with LCF; 37%, without LCF; 86%, p<0.001). The age (63.0±10 vs. 67.8±8.0, p=0.036) and hypertension (51% vs. 77%, p=0.039) were significantly lower in the patients with a successful MI block line than in those without. The duration and amplitude of the local atrial potentials recorded in CS catheter at the MI were significantly longer in the patients with a successful MI block line than in those without (duration; 57.8±14.6 vs. 44.5±11.2, p<0.001, amplitude; 2.24±1.74 vs. 1.51±1.37, p=0.042). Conclusion: A preexistent LCF at the MI reduced the incidence of a successful MI block line. The local atrial electrograms at MI could also provide us additive information for MI line.