Dilatation as a marker of pulmonary veins initiating atrial fibrillation.
BACKGROUND
The pulmonary veins (PVs) have been shown to trigger paroxysmal atrial fibrillation. The relationship of anatomical dimensions versus arrhythmogenicity has not been assessed.


METHODS
The diameters of four PVs were measured by selective PV angiography before ablation in 39 consecutive patients (23 male, mean age 46 years) with only one (25 patients) or two (14 patients) arrhythmogenic PVs (ArPVs). After ablation of ArPVs, no patient had recurrence of atrial fibrillation from the remaining PVs. Comparisons were performed variously between ArPV and non-ArPV, and within and across both groups.


RESULTS
ArPVs were distributed as follows; left superior PV: 40%, left inferior PV: 28%, right superior PV: 26%, and right inferior PV: 6%. Statistical comparisons showed that (1) Triggers of atrial fibrillation were located in the largest PV in 72% of patients, (2) For each PV, the mean diameter of ArPV was significantly larger than that of non-ArPV (p < 0.05), (3) No significant difference was observed in the diameter of the four different ArPVs (range 16.2 +/- 1.3 to 17.2 +/- 4.4).


CONCLUSIONS
In patients with atrial fibrillation initiated from one or two ArPVs, the diameters of ArPVs were significantly larger than those of non-ArPVs irrespective of the specific PV concerned, which might imply a possible role of PV dilatation in the arrhythmogenesis.
Yamane
Teiichi
T
Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France. yamanet1@aol.com
Shah
Dipen C
DC
Jaïs
Pierre
P
Hocini
Mélèze
M
Peng
Jing Tian
JT
Deisenhofer
Isabel
I
Clémenty
Jacques
J
Haïssaguerre
Michel
M
D000328:Adult; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000503:physiopathology; D004594:Electrophysiology; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011859:Radiography; D018570:Risk Assessment; D012680:Sensitivity and Specificity