title: Dissociated pulmonary vein arrhythmia: incidence and characteristics.
abstract: BACKGROUND
  The incidence and characteristics of dissociated arrhythmia confined to the pulmonary vein (PV) following disconnection have not been described in a large number of patients with paroxysmal atrial fibrillation.
  
  
  RESULTS
  This was a prospective study of 152 patients (29 female, mean age 51 +/- 11 years) referred for catheter ablation of drug-refractory paroxysmal atrial fibrillation. Following ostial ablation, the rate and regularity of any dissociated venous activity was analyzed with and without isoproterenol infusion (to achieve a heart rate of 120-140 beats/min). Patients then were classified according to their venous dissociated activity. Group 1 consisted of patients in whom the dissociated PV spike had a slow rhythm >1,200 ms. Group 2 consisted of patients with spontaneous repetitive dissociated discharges confined in the vein with a cycle length <400 ms. A total of 384 PVs were ablated in 152 patients. Disappearance of all venous potentials was observed in 88% of the treated veins; at least one dissociated venous potential was observed in the remaining 12%. Group 1 activity was seen more often than group 2 (23 patients, mean cycle length 2,300 +/- 1,100 ms vs 13 patients, mean cycle length 179 +/- 77 ms). Dissociated PV arrhythmia was seen most often in the right superior PV (19%).
  
  
  CONCLUSIONS
  Dissociation as the endpoint of PV disconnection was observed in 12% of PVs. Due to the capricious nature of this activity, the actual incidence is almost certainly higher. The dissociated venous rhythm usually is slow and, less commonly, is rapid and repetitive.
authors.affiliation: Service du Professeur Clementy-Room 338, 3rd West, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, Bordeaux-Pessac 33604, France. Jacques.clementy@pu.u-bordeaux2.fr
authors.forename: Rukshen
authors.initials: R
authors.lastname: Weerasooriya
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Christophe
authors.initials: C
authors.lastname: Scavée
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
authors.forename: Dipen C
authors.initials: DC
authors.lastname: Shah
authors.forename: Thomas
authors.initials: T
authors.lastname: Arentz
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Salerno
authors.forename: Florence
authors.initials: F
authors.lastname: Raybaud
authors.forename: Kee-Joon
authors.initials: KJ
authors.lastname: Choi
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
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 / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000294:innervation* / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome