title: Effect of pulmonary vein isolation on the left-to-right atrial dominant frequency gradient in human atrial fibrillation.
abstract: BACKGROUND
  We previously demonstrated the existence of a left-to-right atrial dominant frequency gradient during paroxysmal but not persistent atrial fibrillation (AF) in humans. One possible mechanism of the left-to-right dominant frequency gradient involves the role of the pulmonary veins (PVs) in AF maintenance.
  
  
  OBJECTIVE
  The purpose of this study was to examine the effect of PV isolation on the dominant frequency gradient and outcome after PV isolation.
  
  
  METHODS
  Patients with either paroxysmal or persistent AF were studied. Recordings were made from catheters in the coronary sinus (CS), posterior right atrium (RA), and posterior left atrium (LA) during AF before and after PV isolation. Mean left-to-right dominant frequency gradient was measured before and after segmental PV isolation. Patients were followed for AF recurrence after PV isolation.
  
  
  RESULTS
  Twenty-seven patients with paroxysmal (n = 15) or persistent (n = 12) AF were studied. In the paroxysmal group, baseline dominant frequency was greatest in the posterior LA with a significant left-to-right atrial dominant frequency gradient (posterior LA = 6.2 +/- 0.9 Hz, CS = 5.8 +/- 0.8 Hz, posterior RA = 5.4 +/- 0.9 Hz; P <.001). After PV isolation, there was no regional difference in dominant frequency (5.9 +/- 0.7 Hz vs 5.7 +/- 0.6 Hz vs 5.7 +/- 0.7 Hz, respectively; P = NS). In the persistent AF group, there was no overall difference in dominant frequency among sites before or after PV isolation (P = NS); however, patients with long-term freedom from AF after PV isolation had a higher left-to-right dominant frequency gradient compared with patients with recurrent AF (0.4 vs 0.1 Hz; P <.05).
  
  
  CONCLUSIONS
  PV isolation results in a loss in the left-to-right dominant frequency gradient in patients with paroxysmal AF. This finding supports the critical role of PVs in the maintenance of ongoing paroxysmal AF. Patients with persistent AF and a baseline left-to-right dominant frequency gradient have a better success rate with PV isolation alone compared with patients without a dominant frequency gradient.
authors.affiliation: Department of Medicine, Electrophysiology Division, University of Pennsylvania Health System, Philadelphia, 19104, USA.
authors.forename: Sorin
authors.initials: S
authors.lastname: Lazar
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery*; D018780:Body Surface Potential Mapping; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D015986:Confounding Factors, Epidemiologic; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012815:Signal Processing, Computer-Assisted; D016896:Treatment Outcome