title: ATP-induced dormant pulmonary veins originating from the carina region after circumferential pulmonary vein isolation of atrial fibrillation.
abstract: BACKGROUND
  Elimination of transient pulmonary vein recurrences (dormant PVs) induced by an ATP injection and ablation at the PV carina region is an effective strategy for atrial fibrillation (AF) ablation. The relationship between dormant PVs and the PV carina region has not been evaluated.
  
  
  METHODS
  A total of 212 consecutive symptomatic AF patients underwent circumferential PV electrical isolation (CPVEI) with a double lasso technique. They were divided into 2 groups in a retrospective review; Group 1: those given an ATP injection during an intravenous isoproterenol infusion after the CPVEI (n = 106), and Group 2: those in which it was not given after the CPVEI (n = 106). Radiofrequency energy was applied at the earliest dormant PV activation site identified using a Lasso catheter on the CPVEI line and then PV carina region if it was ineffective.
  
  
  RESULTS
  After a successful PVEI, 54 patients (51%) in Group 1 had PV reconnections during an ATP injection. Acute PVEI sites were observed on the carina region within the CPVEI line in the right PVs (16%) and left PVs (10%). Dormant PVs were reisolated at the carina region in the right PVs (23%) and left PVs (26%). The distribution of the dormant PV sites, except for the RIPV, significantly differed from that of the acute PVEI sites (P < 0.05). Further, AF recurred significantly in the Group 2 patients as compared to those in Group 1 during 16 +/- 6.1 months of follow-up (P < 0.05).
  
  
  CONCLUSIONS
  PV carina region origins may partly be responsible for an acute PVEI and potential recurrences.
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan. kkumagai4917@yahoo.co.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Kumagai
authors.forename: Shigeto
authors.initials: S
authors.lastname: Naito
authors.forename: Koki
authors.initials: K
authors.lastname: Nakamura
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Hayashi
authors.forename: Rie
authors.initials: R
authors.lastname: Fukazawa
authors.forename: Chizuru
authors.initials: C
authors.lastname: Sato
authors.forename: Naoki
authors.initials: N
authors.lastname: Takemura
authors.forename: Yuko
authors.initials: Y
authors.lastname: Miki
authors.forename: Etsuko
authors.initials: E
authors.lastname: Fuke
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hori
authors.forename: Koji
authors.initials: K
authors.lastname: Goto
authors.forename: Jotaro
authors.initials: J
authors.lastname: Iwamoto
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
authors.forename: Koichi
authors.initials: K
authors.lastname: Taniguchi
mesh_terms: D000255:Adenosine Triphosphate / Q000008:administration & dosage; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000628:therapy*; D017115:Catheter Ablation; D004351:Drug Resistance; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D011667:Pulmonary Veins / Q000187:drug effects*; D012008:Recurrence; D014057:Tomography, X-Ray Computed
chemical_list: D000255:Adenosine Triphosphate