title: Electrophysiologically guided pulmonary vein isolation during sustained atrial fibrillation.
abstract: BACKGROUND
  Sustained atrial fibrillation (AF) is frequently encountered during pulmonary vein (PV) isolation. The aim of this study was to evaluate the feasibility and safety of PV isolation during sustained AF.
  
  
  RESULTS
  Thirty-seven patients (30 men, age 54 +/- 10 years) underwent Lasso-guided isolation of 87 PVs during sustained AF. Baseline PV electrogram patterns were classified into one of two types: organized, with consistent PV activation sequence; or disorganized, with constant variation of PV activation sequence. In disorganized activity, radiofrequency ablation was performed circumferentially around the Lasso while the earliest PV potential was targeted during organized activity. Complete left atrial (LA) to PV block during AF was identified by abolition or dissociation of all sharp potentials recorded within the vein. PV isolation then was verified during sinus rhythm. Baseline activation patterns of PV potential were organized in 32 PVs (37%) [more frequently in inferior veins than superior veins (53% vs 26%, P = 0.01)] and disorganized in 55 PVs (63%). In 59 of 87 PVs, isolation was begun and completed during AF. Radiofrequency ablation organized PV activation sequence in 75% prior to isolation. LA-PV block was confirmed during sinus rhythm in 54 (92%) of 59 PVs. In 28 of 87 PVs, sinus rhythm was restored before complete LA-PV block. Complete isolation was achieved in all 87 PVs without complications.
  
  
  CONCLUSIONS
  PV isolation can be effectively and safely performed during sustained AF, preceded in most cases by organization of PV electrogram activity. This strategy may be the preferred alternative to multiple intraprocedural cardioversions.
authors.affiliation: Service du Professeur Clementy, Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France. Jacques.clementy@pu.u-bordeaux2.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Christophe
authors.initials: C
authors.lastname: Scavée
authors.forename: Rukshen
authors.initials: R
authors.lastname: Weerasooriya
authors.forename: Dipen C
authors.initials: DC
authors.lastname: Shah
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Kee-Joon
authors.initials: KJ
authors.lastname: Choi
authors.forename: Florence
authors.initials: F
authors.lastname: Raybaud
authors.forename: Jacques
authors.initials: J
authors.lastname: Clémenty
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004554:Electric Countershock; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins; D016896:Treatment Outcome