Pulmonary Vein Isolation With Ablation Index via Single Transseptal Crossing: Critical Role of Carina Isolation

Raphael Rosso*, Ehud Chorin, Arie Lorin Schwartz, Yuval Levi, Aviram Hochstadt, Sami Viskin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Aim: Reconnection of the pulmonary veins (PVs) is the most common reason for the recurrence of atrial fibrillation (AF). The ablation index is a marker of ablation lesion quality that achieves high percentages of first-pass isolation and improved AF ablation results. Most operators use a double transseptal approach with confirmation of PV isolation with a circular mapping catheter. In the present study we aimed to show that an ablation index-guided procedure using a single transseptal approach and ablation catheter only would achieve adequate PV isolation while demonstrating the critical role of the carina in PV isolation. Method: Sixty-six (66) consecutive patients with paroxysmal AF were included. Thirty-four (34) patients underwent wide antral circumferential ablation (WACA-only) and 32 underwent WACA+ (WACA + empiric carina isolation). All procedures were performed via single transseptal approach. Pulmonary vein isolation was confirmed with the use of a circular mapping catheter in both groups. Results: Compared to WACA-only, WACA+ increased the odds of PV isolation from 65% to 94% (p=0.011). In the WACA-only procedure, ablation of the carina was needed to achieve PV isolation. At the 18-month follow-up (interquartile range 15.2–20.8 months), freedom from AF was 84% for the entire cohort. Conclusions: Our study confirmed the high success rate of PV isolation using the ablation index and showed that this can be achieved via a single transseptal crossing. Our study confirmed the role of the carina in PV isolation.

Original languageEnglish
Pages (from-to)1373-1378
Number of pages6
JournalHeart Lung and Circulation
Issue number9
StatePublished - Sep 2021


  • Ablation index
  • Atrial fibrillation
  • Carina
  • Outcome
  • Radiofrequency ablation


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