Clinical Implication
AEPVR had the similar distribution and EGM characteristics as late
epicardial PVR found in repeat procedures which was considered
arrhythmogenic, indicating their common mechanism and the role in AF
recurrence. The potential benefit of treating AEPVRs was reflected by
the outcome showing no statistical difference between AEPVR and Control
groups. According to the analysis, it is necessary to take the anatomic
characteristics and multiple ablation-related parameters e.g., AI,
impedance drop, inter-lesion distance into comprehensive consideration
when evaluating the possibility of AEPVR. Although the duration for
post-ablation waiting has been questioned[25], we
recommend a 40-minute waiting period given the longer time for AEPVR to
appear, especially when energy delivery has to be limited on the
posterior wall. Based on the possibility late manifestation of ICB
conduction, reconnection from the right carina to right atrium should be
excluded after the observation period even in the absence of residual
potentials when the circular ablation is completed.