Atrio-pulmonary vein conduction delay during pulmonary vein isolation for atrial fibrillation is related to vein anatomy, age, and focal activity.
BACKGROUND
During pulmonary vein isolation for treatment of atrial fibrillation (AF), a significant delay in atrio-pulmonary vein (PV) conduction is often observed. We sought to investigate this conduction delay in various PV in individual patients.


METHODS
We studied 385 AF patients (mean age: 54 +/- 11 years, 74 women) who underwent segmental PV isolation (PVI). A circular decapolar catheter was used to record electrograms at the PV ostia. The time delay from local atrial potential to PV potential was measured in each vein. Conduction delay (CD) was defined as the longest time interval >20 ms observed during PVI.


RESULTS
For patients treated for the first time, CD was more frequently observed in the left common and the right and left superior PVs (84.2%, 67.9%, and 66.2%, respectively) and less frequently in the left and right inferior and right middle PVs (54.3%, 40.0%, and 30.8%, respectively). Veins with CD required more ablation applications (12.4 vs 9.9) and a higher ablated segmental fraction (72.3% vs 63.7%). CD was observed in 75.2% (109/145) of the PVs in which focal activity was detected. Older patients had a higher incidence of PVs with CD than younger patients. There were no gender differences.


CONCLUSIONS
The incidence of CD was highest in the left common and superior PVs, in older patients and in PVs with focal activity. PVs with CD required more ablation applications and a larger area of ablation around the ostia. These observations were not found during repeat procedures.
Off
Morten K
MK
Institute of Medicine, Department of Heart Disease, Haukeland University Hospital, University of Bergen, Bergen, Norway. mortenoff@hotmail.com
Solheim
Eivind
E
Hoff
Per I
PI
Schuster
Peter
P
Ohm
Ole-Jørgen
OJ
Chen
Jian
J
D017677:Age Distribution; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011667:Pulmonary Veins / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome