title: Noninvasive vectorcardiographic evaluation of pulmonary vein-atrial reconnection after pulmonary vein isolation for atrial fibrillation.
abstract: BACKGROUND
  Although pulmonary vein (PV)-left atrium (LA) reconnection is associated with recurrence of atrial fibrillation (AF) in patients who undergo pulmonary vein isolation (PVI), no noninvasive method for evaluating PV reconnection has yet been established.
  
  
  OBJECTIVE
  The purpose of this study was to examine whether PV-LA reconnection could be detected noninvasively by analyzing the change of P-loop configuration by vectorcardiography (VCG).
  
  
  METHODS
  The study included 80 patients with paroxysmal AF (8 female; mean age 58 ± 10 years) who underwent PVI. VCG was prospectively analyzed by recording during the procedure (before and after PVI) and 1 year after the procedure to noninvasively evaluate PV-LA reconnection.
  
  
  RESULTS
  All patients showed a significant antero-leftward shift in the middle portion of the P loop on the horizontal plane of VCG, with an increase of the area within the P loop after the initial PVI (2.4 ± 1.7 vs 4.6 ± 2.7 × 10(3) mV(2), P <.001). Sixty-three (78.8%) patients without AF recurrence demonstrated no remarkable change in the P-loop area after 16 ± 11 months of follow-up (4.4 ± 2.7 vs 4.1 ± 2.5 × 10(3) mV(2), P = .51), whereas 17 (21.2%) patients with AF recurrence demonstrated P-loop reversion to the preprocedural P-loop morphology, with a decrease of P-loop area (5.6 ± 2.7 vs 3.2 ± 1.7 × 10(3) mV(2), P <.001).
  
  
  CONCLUSIONS
  Change of the P loop on VCG was associated with subsequent PV-LA reconnection. VCG is helpful as a noninvasive method for detecting PV-LA reconnection after PVI for paroxysmal AF.
authors.affiliation: Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Seigo
authors.initials: S
authors.lastname: Yamashita
authors.forename: Taro
authors.initials: T
authors.lastname: Date
authors.forename: Teiichi
authors.initials: T
authors.lastname: Yamane
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Matsuo
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ito
authors.forename: Ryohsuke
authors.initials: R
authors.lastname: Narui
authors.forename: Mika
authors.initials: M
authors.lastname: Hioki
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Tanigawa
authors.forename: Tokiko
authors.initials: T
authors.lastname: Nakane
authors.forename: Michifumi
authors.initials: M
authors.lastname: Tokuda
authors.forename: Keiichi
authors.initials: K
authors.lastname: Inada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshimura
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000503:physiopathology*; D012372:ROC Curve; D012008:Recurrence; D014672:Vectorcardiography