Dissociated pulmonary vein arrhythmia: incidence and characteristics.
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.
Weerasooriya
Rukshen
R
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
Jaïs
Pierre
P
Scavée
Christophe
C
Macle
Laurent
L
Shah
Dipen C
DC
Arentz
Thomas
T
Salerno
Jorge A
JA
Raybaud
Florence
F
Choi
Kee-Joon
KJ
Hocini
Mélèze
M
Clémenty
Jacques
J
Haïssaguerre
Michel
M
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