title: Mechanism of immediate recurrences of atrial fibrillation after restoration of sinus rhythm.
abstract: An immediate recurrence of AF may occur after restoration of sinus rhythm. Although pulmonary vein (PV) isolation has been shown to prevent immediate recurrence of AF, the specific trigger for immediate recurrence of AF has not been described. In 89 consecutive patients (mean age 53 +/- 11 years) who had sinus rhythm restored by spontaneous or transthoracic cardioversion in the course of a PV isolation procedure, electrograms recorded within a PV and in the adjacent left atrium were analyzed to determine the mechanism of initiation of immediate recurrence of AF. Immediate recurrence of AF was defined as a recurrence of AF within 90 seconds after restoration of sinus rhythm. There were 124 episodes of immediate recurrence of AF at a mean of 18 +/- 23 seconds after cardioversion. Recordings within the PV that triggered the immediate recurrence of AF were available in 23 (19%) of the 124 immediate recurrence of AF episodes. Among these 23 episodes of immediate recurrence of AF, all (100%) were triggered by a burst of PV tachycardia (P < 0.001). The coupling interval and prematurity index (coupling interval/preceding sinus cycle length) of the premature depolarizations that did and did not trigger immediate recurrence of AF were 246 +/- 67 ms and 0.30 +/- 0.11 vs 378 +/- 117 ms and 0.49 +/- 0.16, respectively (P < 0.01). Immediate recurrence of AF was abolished by PV isolation. The mechanism of immediate recurrence of AF is a burst of PV tachycardia, not a single premature depolarization. Immediate recurrence of AF identifies patients with AF in whom the PVs may play a major role in the initiation of AF.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozaydin
authors.forename: Christoph
authors.initials: C
authors.lastname: Scharf
authors.forename: Steve W K
authors.initials: SW
authors.lastname: Lai
authors.forename: Burr
authors.initials: B
authors.lastname: Hall
authors.forename: Peter
authors.initials: P
authors.lastname: Cheung
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Knight
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology*; D004554:Electric Countershock / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology*; D012008:Recurrence; D013610:Tachycardia / Q000209:etiology