title: Relation between pulmonary vein firing and extent of left atrial-pulmonary vein connection in patients with atrial fibrillation.
abstract: BACKGROUND
  The purpose of this study was to measure the extent of left atrial-pulmonary vein (LA-PV) connections and determine the relation to PV firing in patients with atrial fibrillation (AF).
  
  
  RESULTS
  Ten close-bipolar (1 mm-spacing) Lasso electrograms were recorded circumferentially around 210 PVs (excluding 2 right middle PVs and 4 left common trunks) in 62 patients with AF. PV firing was provoked by isoproterenol (4 microg/min) and cardioversion of pacing-induced AF. The width of each LA-PV connection was measured in tenths of PV circumference, based on number of continuous close-bipolar Lasso electrode sites required for ablation (10% for each close-bipolar electrode site). One, 2, or 3 to 4 discrete LA-PV connections (discrete connection defined by ablation along 10% to 30% of PV circumference) were present in 18 (9%), 31 (14%), and 32 (15%) of 210 PVs, respectively: 1 broad connection (ablation along continuous 40% to 80% circumference) in 46 (22%) PVs; 1 broad plus other broad or discrete connections in 54 (26%) PVs; and a circumferential connection (ablation along 90% to 100%) in 29 (14%) PVs. Circumferential LA-PV connections were more common in superior than in inferior PVs (20% versus 7%, P<0.01). There was no major difference in distribution of the other types of LA-PV connections between the four PVs. PV firing occurred in 27%, 47%, and 72% of PVs with discrete only, broad and circumferential connections, respectively (P<0.01). Dissociated PV potentials after isolation were more common in arrhythmogenic (firing) PVs (32% versus 8%, P<0.01).
  
  
  CONCLUSIONS
  The extent of LA-PV connections corresponds with arrhythmognesis. The incidence of PV firing increases with progressively wider LA-PV connections (discrete versus broad versus circumferential).
authors.affiliation: Cardiac Arrhythmia Research Institute and the Department of Medicine, University of Oklahoma Health Sciences Center, 1200 Everett Drive (TUH-6E-103), Oklahoma City, Okla 73104, USA. hiroshi-nakagawa@ouhsc.edu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aoyama
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Beckman
authors.forename: Sunny S
authors.initials: SS
authors.lastname: Po
authors.forename: Richard
authors.initials: R
authors.lastname: Wu
authors.forename: Deborah
authors.initials: D
authors.lastname: Lockwood
authors.forename: Peter
authors.initials: P
authors.lastname: Spector
authors.forename: James D
authors.initials: JD
authors.lastname: Calame
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Lustgarten
authors.forename: Lisa
authors.initials: L
authors.lastname: Herring
authors.forename: Can
authors.initials: C
authors.lastname: Hasdemir
authors.forename: Dalip
authors.initials: D
authors.lastname: Singh
authors.forename: Ralph
authors.initials: R
authors.lastname: Lazzara
authors.forename: Warren M
authors.initials: WM
authors.lastname: Jackman
mesh_terms: D000200:Action Potentials; D000318:Adrenergic beta-Agonists; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery; D006328:Cardiac Catheterization / Q000295:instrumentation; D017115:Catheter Ablation; D004562:Electrocardiography; D004566:Electrodes; D004867:Equipment Design; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D007545:Isoproterenol; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000473:pathology / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D000318:Adrenergic beta-Agonists; D007545:Isoproterenol