Purpose

After antral pulmonary vein isolation (PVI), electrical potentials may persist deep in the right superior pulmonary vein (RSPV). Whether these potentials signify true pulmonary vein potential (PVP) (implying inadequate RSPV isolation) or are far-field potentials (FFP) from the superior vena cava (SVC) is unclear. Here, we attempt to assess the incidence of persistent potentials in RSPV post-isolation and methods to differentiate PVP from FFP.

Methods

Following PVI, we mapped the RSPV and the SVC with simultaneously placed catheters. We recorded the incidence of SVC potentials, RSPV potentials, and distance between the 2 structures. When RSPV potentials were present, we assessed (1) relationship to SVC potentials, (2) RSPV-SVC distance, and (3) responses on pacing from either site.

Results

Among 43 consecutive post-PVI patients, 39 (91%) patients had SVC electrical activity but only 10 had persistent RSPV potentials. Of these, 2/10 had true PVP, and 8 were FFP from SVC. Bipolar electrogram morphology did not differentiate PVP from FFP, but low-amplitude (5 mA) SVC pacing was an effective maneuver. However, high-amplitude (≥ 10 mA) pacing from SVC and/or RSPV could result in far-field capture of the other site even when RSPV was devoid of electrical activity. Average RSPV-SVC distance was 15.9 mm.

Conclusions

Persistent RSPV potentials occur rarely post-PVI despite the close proximity to electrically active SVC. When present, true PVP can be differentiated from FFP by low-amplitude pacing from SVC. Bipolar EGM morphology and high-amplitude pacing are unreliable at differentiating these potentials.

中文翻译：

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隔离后右上肺静脉电活动的意义及其与上腔静脉电位的关系

目的

窦状肺静脉隔离 (PVI) 后，电位可能会在右上肺静脉 (RSPV) 深处持续存在。这些电位是否表示真正的肺静脉电位 (PVP)（意味着 RSPV 隔离不足）还是来自上腔静脉 (SVC) 的远场电位 (FFP) 尚不清楚。在这里，我们试图评估 RSPV 隔离后持续电位的发生率以及区分 PVP 和 FFP 的方法。

方法

在 PVI 之后，我们用同时放置的导管绘制了 RSPV 和 SVC。我们记录了 SVC 电位、RSPV 电位和 2 个结构之间的距离的发生率。当 RSPV 电位存在时，我们评估了 (1) 与 SVC 电位的关系，(2) RSPV-SVC 距离，以及 (3) 对任一部位起搏的反应。

结果

在 43 名连续 PVI 后患者中，39 名 (91%) 患者有 SVC 电活动，但只有 10 名患者有持续的 RSPV 电位。其中，2/10 具有真正的 PVP，8 是来自 SVC 的 FFP。双极电图形态不能区分 PVP 和 FFP，但低振幅 (5 mA) SVC 起搏是一种有效的操作。然而，即使在 RSPV 没有电活动的情况下，从 SVC 和/或 RSPV 起的高振幅 (≥ 10 mA) 起搏也可能导致其他部位的远场捕获。平均 RSPV-SVC 距离为 15.9 毫米。

结论

尽管靠近电活性 SVC，但在 PVI 后很少出现持续的 RSPV 电位。当存在时，真正的 PVP 可以通过 SVC 的低幅度起搏与 FFP 区分开来。双极 EGM 形态和高振幅起搏在区分这些电位时是不可靠的。