title: The effects of pulmonary vein isolation on the dominant frequency and organization of coronary sinus electrical activity during permanent atrial fibrillation.
abstract: BACKGROUND
  Pulmonary vein isolation (PVI) has been shown to suppress atrial fibrillation (AF). We examined the effects of PVI on disorganization and dominant frequencies (DF) in patients with permanent AF.
  
  
  RESULTS
  Twenty-eight patients with permanent AF (>6 months) who failed > or =1 antiarrhythmic drugs (AAD) and > or =2 cardioversions (CV) with AF reversion <30 minutes after CV were included. PVI and isolation of DFs in pulmonary veins (PVs) was performed during AF. Fast Fourier transformations of atrial electrograms were performed. Disorganization index (DI) was defined as the percentage of time spent in type III AF during 1-minute continuous recordings. The temporal stability and reproducibility of DIs from the same sites were verified over time prior to ablation. Highly disorganized AF activity concentrated in the posterior left atrium (PLA) including sites at the left atrial (PV-LA) junction (55.7% of sites in PLA, 32.9% in septum, and 11.4% in other sites). DF and DI from the coronary sinus (CS) before and after PVI were analyzed. PVI reduced the DI (14.3 +/- 25.0% before PVI vs 4.6 +/- 8.6% after PVI; P < 0.02). There was significant reduction of DI in 26 of 28 patients. The DF remained unchanged (5.6 +/- 1.3 Hz before PVI vs 5.9 +/- 0.9 Hz after PVI; P = 0.31). After a follow-up of 30 +/- 11 months, 15 (54%) of patients are free of symptomatic AF, 3 (10%) in sinus rhythm on AAD, 5 (18%) with paroxysmal AF, 4 (14%) in chronic AF, and 1 (4%) with atypical flutter.
  
  
  CONCLUSIONS
  In the vast majority of patients with chronic AF, PVI reduces AF disorganization without affecting the DF as measured in the CS.
authors.affiliation: Texas Heart Institute/St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Razavi
authors.forename: Shulong
authors.initials: S
authors.lastname: Zhang
authors.forename: Scott
authors.initials: S
authors.lastname: Delapasse
authors.forename: Donghui
authors.initials: D
authors.lastname: Yang
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Ai
authors.forename: Biswajit
authors.initials: B
authors.lastname: Kar
authors.forename: George
authors.initials: G
authors.lastname: Younis
authors.forename: Abdi
authors.initials: A
authors.lastname: Rasekh
authors.forename: Jie
authors.initials: J
authors.lastname: Cheng
mesh_terms: D000200:Action Potentials; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D003331:Coronary Vessels / Q000503:physiopathology*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology*