Multiple sources initiating atrial fibrillation from a single pulmonary vein identified by a circumferential catheter.
The pulmonary veins are the predominant source of ectopic activity initiating AF. The reproducibility of intrapulmonary vein activation during ectopic activity and/or initiation of multiple AF episodes was examined. Eighty-nine pulmonary veins (PVs) among 29 patients undergoing radiofrequency ablation of AF were studied with a 15- to 20-mm diameter, circumferential PV catheter equipped with ten electrodes and a deflectable shaft. Local electrograms were recorded simultaneously during sinus rhythm, ectopic activity, or AF onset, spontaneously or induced via the catheter left in a stable position. Fifty-four arrhythmogenic veins were identified, 39 showing isolated ectopy, and 8 displayed repetitive ectopy (in salvos). The earliest site of activation and the sequence of intra-PV activation during isolated ectopy was identical to that observed during consecutive ectopic complexes in 77% and variable in 23% during isolated ectopy. The earliest activity was sometimes limited to a single bipole. During repetitive ectopy and AF initiation, multiple sources and/or variable activation patterns were noted in 53% of instances, indicating the presence of multiple arrhythmogenic foci within the same PV. Simultaneous electrogram recordings with a circumferential PV catheter identified the presence of multiple arrhythmogenic foci within a single PV.
Hocini
M
M
Hôpital du Haut-Lévèque, CHU de Bordeaux, France. jacques.clementy@pu.u-bordeaux2.fr
Haïssaguerre
M
M
Shah
D
D
Jaïs
P
P
Peng
J T
JT
Yamane
T
T
Deisenhofer
I
I
Garrigue
S
S
Fuimaono
K
K
Pike
R
R
Clémenty
J
J
D001281:Atrial Fibrillation / Q000209:etiology* / Q000601:surgery; D018880:Atrial Premature Complexes / Q000209:etiology / Q000503:physiopathology; D017115:Catheter Ablation; D002404:Catheterization / Q000295:instrumentation*; D002405:Catheterization, Central Venous; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology* / Q000601:surgery; D015203:Reproducibility of Results; D014652:Vascular Diseases / Q000150:complications* / Q000601:surgery