title: Prevalence, electrophysiological properties, and clinical implications of dissociated pulmonary vein activity following pulmonary vein antrum isolation.
abstract: The objective of this study was to investigate the prevalence, electrophysiologic properties, and clinical implications of dissociated pulmonary vein (PV) activity after PV antrum isolation (PVAI) in patients with paroxysmal atrial fibrillation (AF). One hundred seventy-three consecutive patients (61 ±10 years old, 141 men) with drug-refractory paroxysmal AF who underwent AF ablation were analyzed. After identification of arrhythmogenic foci, PVAI was performed in all patients. Of the total 346 isolated ipsilateral PVs, 97 (28.0%) were silent, 35 (10.1%) demonstrated isolated ectopic beats, 209 (60.4%) demonstrated a regular ectopic rhythm, and 5 (1.4%) demonstrated fibrillatory activity. The culprit thoracic vein was identified in 77 patients (44.5%). After isolation of ipsilateral PVs, venous activity was observed in 68 (79.1%) and 178 (68.5%) PVs among the 86 PVs with AF triggers and 260 PVs without AF triggers, respectively (p = 0.06). There was no significant difference in the incidence of acute PV reconnections exposed by adenosine triphosphate between the 97 silent ipsilateral PVs and 209 ipsilateral PVs with dissociated PV activity after the PVAI (20.6% vs 19.1%, p = 0.78). After a mean follow-up of 48.7 ± 7.9 months there was no significant difference in rates of freedom from atrial tachyarrhythmias after a single procedure between patients with and those without dissociated activity (62.1% vs 63.3%, p = 0.74, log-rank test). In conclusion, although dissociated PV activity appearing after PV isolation is an important electrophysiologic finding to prove bidirectional conduction block between the left atrium and the PV during the procedure, the clinical implications might be limited.
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yonegahamadori, Kanagawa-ken, Japan. mshinsuke@k3.dion.ne.jp
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Taishi
authors.initials: T
authors.lastname: Kuwahara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kobori
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Asumi
authors.initials: A
authors.lastname: Takei
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D055724:Electrophysiological Phenomena / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011667:Pulmonary Veins / Q000503:physiopathology* / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D013614:Tachycardia, Paroxysmal / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome