title: Frequency mapping of the pulmonary veins in paroxysmal versus permanent atrial fibrillation.
abstract: BACKGROUND
  The pulmonary veins (PVs) are a dominant source of triggers initiating atrial fibrillation (AF). While recent evidence implicates these structures in the maintenance of paroxysmal AF, their role in permanent AF is not known. The current study aims to compare the contribution of PV activity to the maintenance of paroxysmal and permanent AF.
  
  
  RESULTS
  Thirty-four patients with paroxysmal AF (n = 20) or permanent AF (n = 14) undergoing ablation were studied. Prior to ablation, 32 seconds of electrograms were acquired from each PV and the coronary sinus (CS). The frequency of activity of each PV and CS was defined as the highest amplitude frequency on spectral analysis. The effects of ablation on the AF cycle length (AFCL) and frequency and on AF termination were determined. Significant differences were observed between paroxysmal and permanent AF. Paroxysmal AF demonstrates higher frequency PV activity (11.0 +/- 3.1 vs 8.8 +/- 3.0 Hz; P = 0.0003) but lower CS frequency (5.8 +/- 1.2 vs 6.9 +/- 1.4 Hz; P = 0.01) and longer AFCL (182 +/- 17 vs 158 +/- 21 msec; P = 0.002), resulting in greater PV to atrial frequency gradient (7.2 +/- 2.2 vs 4.2 +/- 2.9 Hz; P = 0.006). PV isolation in paroxysmal AF resulted in a greater decrease in atrial frequency (1.0 +/- 0.7 vs -0.05 +/- 0.4 Hz; P < 0.0001), greater prolongation of the AFCL (49 +/- 35 vs 5 +/- 6 msec; P < 0.0001), and more frequent AF termination (11/20 vs 0/14; P = 0.0007) compared to permanent AF.
  
  
  CONCLUSIONS
  Paroxysmal AF is associated with higher frequency PV activity and lesser CS frequency compared to permanent AF. Isolation of the PVs had a greater impact on the fibrillatory process in paroxysmal AF compared to permanent AF, suggesting that while the PVs have a role in maintaining paroxysmal AF, these structures independently contribute less to the maintenance of permanent AF.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France. prash.sanders@adelaide.edu.au
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.forename: Chrishan J
authors.initials: CJ
authors.lastname: Nalliah
authors.forename: Rémi
authors.initials: R
authors.lastname: Dubois
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Martin
authors.initials: M
authors.lastname: Rotter
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.forename: Fréderic
authors.initials: F
authors.lastname: Sacher
authors.forename: Li-Fern
authors.initials: LF
authors.lastname: Hsu
authors.forename: Anders
authors.initials: A
authors.lastname: Jönsson
authors.forename: Mark D
authors.initials: MD
authors.lastname: O'Neill
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017115:Catheter Ablation / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000502:physiology*