Relation between pulmonary vein firing and extent of left atrial-pulmonary vein connection in patients with atrial fibrillation.
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).
Nakagawa
Hiroshi
H
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
Aoyama
Hiroshi
H
Beckman
Karen J
KJ
Po
Sunny S
SS
Wu
Richard
R
Lockwood
Deborah
D
Spector
Peter
P
Calame
James D
JD
Lustgarten
Daniel L
DL
Herring
Lisa
L
Hasdemir
Can
C
Singh
Dalip
D
Lazzara
Ralph
R
Jackman
Warren M
WM
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
D000318:Adrenergic beta-Agonists; D007545:Isoproterenol