A single pulmonary vein as electrophysiological substrate of paroxysmal atrial fibrillation.
BACKGROUND
It has been demonstrated that pulmonary veins (PVs) play an important role in initiation and maintenance of paroxysmal atrial fibrillation (AF). However, it is not clearly known whether a single PV acts as electrophysiological substrate for paroxysmal AF.


RESULTS
This study included five patients with paroxysmal AF. All patients underwent complete PV isolation with continuous circular lesions (CCLs) around the ipsilateral PVs guided by a three-dimensional mapping system. Irrigated radiofrequency (RF) delivery was performed during AF on the right-sided CCLs in two patients and on the left-sided CCLs in three patients. The incomplete CCLs resulted in a change from AF to atrial tachycardia (AT), which presented with an identical atrial activation sequence and P wave morphology. Complete CCLs resulted in AF termination with persistent PV tachyarrhythmias within the isolated PV in all five patients. PV tachyarrhythmia within the isolated PV was PV fibrillation from the left common PV (LCPV) in two patients, PV tachycardia from the right superior PV (RSPV) in two patients, and from the left superior PV in one patient. All sustained PV tachyarrhythmias persisted for more than 30 minutes, needed external cardioversion for termination in four patients and a focal ablation in one patient. After the initial procedure, an AT from the RSPV occurred in a patient with PV fibrillation within the LCPV, and was successfully ablated.


CONCLUSIONS
In patients with paroxysmal AF, sustained PV tachyarrhythmias from a single PV can perpetuate AF. Complete isolation of all PV may provide good clinical outcome during long-term follow-up.
Huang
He
H
II. Med. Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany.
Wang
Xingxiang
X
Chun
Julian
J
Ernst
Sabine
S
Satomi
Kazuhiro
K
Ujeyl
Amaar
A
Chu
Huimin
H
Shi
Haifeng
H
Bänsch
Dietmar
D
Antz
Matthias
M
Kuck
Karl-Heinz
KH
Ouyang
Feifan
F
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology*; D017115:Catheter Ablation / Q000379:methods / Q000706:statistics & numerical data; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000502:physiology*