Mechanistic significance of intermittent pulmonary vein tachycardia in patients with atrial fibrillation.
BACKGROUND
The significance of intermittent tachycardia within a pulmonary vein (PV) during an episode of atrial fibrillation (AF) is unclear. The aim of this study was to determine the role that intermittent PV tachycardias play in AF.


RESULTS
In 56 patients with AF, segmental ostial ablation guided by PV potentials was performed to isolate the PVs. The characteristics of intermittent PV tachycardias and the inducibility of AF before and after PV isolation were analyzed prospectively. During AF, a PV tachycardia (mean cycle length 130 +/- 30 msec) with exit block to the left atrium was present in 93% of left superior, 80% of left inferior, 73% of right superior, and 7% of right inferior PVs. The site of shortest cycle length during AF alternated between the PVs and left atrium 1 to 13 times per minute. Complete isolation was achieved in 168 (94%) of 178 targeted PVs. In 99% of PVs, tachycardia resolved upon isolation. AF was persistent before and after PV isolation in 100% and 27% of patients, respectively (P < 0.001).


CONCLUSIONS
Intermittent bursts of tachycardia are observed within multiple PVs during persistent AF in a majority of patients. After PV isolation, PV tachycardias almost always resolve, and AF is less likely to be inducible or persistent. These observations suggest a dynamic interplay between the atria and PVs, with intermittent bursts of PV tachycardia being dependent on left atrial input and with the probability of persistent AF diminishing when PV tachycardias are eliminated by PV isolation.
Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0022, USA. oralh@umich.edu
Hakan
H
Oral
Mehmet
M
Ozaydin
Hiroshi
H
Tada
Aman
A
Chugh
Christoph
C
Scharf
Sohail
S
Hassan
Steve
S
Lai
Radmira
R
Greenstein
Frank
F
Pelosi
Bradley P
BP
Knight
S Adam
SA
Strickberger
Fred
F
Morady
D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology* / Q000601:surgery; D012008:Recurrence; D013610:Tachycardia / Q000150:complications / Q000503:physiopathology* / Q000601:surgery