Frequency mapping of the pulmonary veins in paroxysmal versus permanent atrial fibrillation.
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.
Sanders
Prashanthan
P
Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France. prash.sanders@adelaide.edu.au
Nalliah
Chrishan J
CJ
Dubois
Rémi
R
Takahashi
Yoshihide
Y
Hocini
Mélèze
M
Rotter
Martin
M
Rostock
Thomas
T
Sacher
Fréderic
F
Hsu
Li-Fern
LF
Jönsson
Anders
A
O'Neill
Mark D
MD
Jaïs
Pierre
P
Haïssaguerre
Michel
M
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*