ATP-induced dormant pulmonary veins originating from the carina region after circumferential pulmonary vein isolation of atrial fibrillation.
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.
Kumagai
Koji
K
Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan. kkumagai4917@yahoo.co.jp
Naito
Shigeto
S
Nakamura
Koki
K
Hayashi
Tatsuya
T
Fukazawa
Rie
R
Sato
Chizuru
C
Takemura
Naoki
N
Miki
Yuko
Y
Fuke
Etsuko
E
Tanaka
Yasuaki
Y
Hori
Yasuhiko
Y
Goto
Koji
K
Iwamoto
Jotaro
J
Aonuma
Kazutaka
K
Oshima
Shigeru
S
Taniguchi
Koichi
K
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
D000255:Adenosine Triphosphate