Atrial fibrillation in patients with Wolff-Parkinson-White syndrome: role of pulmonary veins.
OBJECTIVE
We aimed to characterize electrophysiological properties of pulmonary veins (PVs) in patients with Wolff-Parkinson-White (WPW) syndrome and atrial fibrillation (AF), and to compare them to those in patients with WPW without AF.


RESULTS
A total of 31 patients (mean age 40 ± 15 years, 23 males) with WPW were recruited: 16 patients with (AF group) and 15 without (controls) a history of AF. The basic electrophysiological (EPS) and echocardiographic data were not different between the 2 groups. Effective refractory periods (ERPs) of PVs were significantly shorter in the AF group compared to controls: left superior (LS) PV ERP 185±29 versus 230 ± 24 ms, P = 0.001; left inferior PV ERP 198 ± 25 versus 219 ± 26 ms, P = 0.04; right superior (RS) PV ERP 207 ± 25 versus 236 ± 19 ms, P = 0.001; right inferior PV ERP 208 ± 30 versus 240 ± 19 ms, P = 0.003. Maximal veno-atrial conduction delay (i.e., the maximal prolongation of interval from stimulus delivered at PV ostia to proximal coronary sinus after extrastimulus compared to the basic drive cycle) was longer in the AF group when pacing from LSPV (69.3 ± 37.9 vs 32.6 ± 16.1 ms, P = 0.01) and RSPV (74.1 ± 25.9 vs 50.2 ± 26.5 ms, P = 0.04). During EPS, AF was induced more often in the AF group (n = 7) compared to controls (n = 1; P = 0.04). Follow-up revealed that AF recurred in 3 patients in the AF group and none of the controls.


CONCLUSIONS
Patients with WPW syndrome and AF have shorter ERPs of PVs and greater maximal veno-atrial conduction delay compared to patients with WPW without AF. These findings suggest a potential role of PVs in the development of AF in patients with WPW.
Institute of Cardiology, Cardiac Arrhythmias Department, Warsaw, Poland. pderejko@yahoo.com
Paweł
P
Derejko
Lukasz Jan
LJ
Szumowski
Prashanthan
P
Sanders
Wojciech
W
Krupa
Robert
R
Bodalski
Michał
M
Orczykowski
Piotr
P
Urbanek
Joanna
J
Zakrzewska
Han S
HS
Lim
Dennis H
DH
Lau
Jacek
J
Kuśnierz
Franciszek
F
Walczak
D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D020517:Atrial Appendage / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D001283:Atrioventricular Node / Q000502:physiology; D017115:Catheter Ablation; D054326:Coronary Sinus / Q000503:physiopathology; D004562:Electrocardiography; D055724:Electrophysiological Phenomena; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology*; D012008:Recurrence; D012032:Refractory Period, Electrophysiological / Q000502:physiology; D016896:Treatment Outcome; D014463:Ultrasonography; D016278:Ventricular Function, Right / Q000502:physiology; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*
D000889:Anti-Arrhythmia Agents