title: Efficacy of additional radiofrequency applications for spontaneous dissociated pulmonary vein activity after pulmonary vein isolation in patients with paroxysmal atrial fibrillation.
abstract: BACKGROUND
  The aim is to evaluate the efficacy of additional radiofrequency ablation (RFCA) for spontaneous dissociated pulmonary vein activity (DPV-spike) after PV isolation (PVI) in patients with paroxysmal atrial fibrillation (AF).
  
  
  METHODS
  One hundred fifty-two consecutive patients with paroxysmal AF referred for RFCA were enrolled. When DPV-spike was documented after PVI, we randomly assigned these patients to receive additional RFCA for DPV-spike or only PVI. We divided them into 4 groups: 87 patients without DPV-spike after PVI (No-spike group), 31 without DPV-spike after additional RFCA (Successful group), 8 with remaining DPV-spike after additional RFCA (Unsuccessful group), and 26 with DPV-spike after only PVI (Spike group). AF recurrence was evaluated among the 4 groups.
  
  
  RESULTS
  After PVI, DPV-spike was documented in 87 PVs (14%) from 65 patients. During 16 ± 9 months of follow-up, the incidence of the freedom from AF was significantly higher in the No-spike group than that in the Spike group and Unsuccessful group (P < 0.05), and tended to be higher in the Successful group than that in the Spike group and Unsuccessful group (P = 0.08 and 0.11, respectively). In a multivariate analysis, the remaining PV-spike after ablation was an independent predictor of AF recurrence (HR 2.44; CI 1.10-5.43, P < 0.05). No major complications including PV stenosis were observed during the follow-up.
  
  
  CONCLUSIONS
  DPV-spike after PVI may be associated with higher electrical activity within the PVs and may be one of the risk factors for AF recurrence. Additional RFCA for DPV-spike was effective to reduce the AF recurrence after PVI.
authors.affiliation: Department of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Doi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Satomi
authors.forename: Hisaki
authors.initials: H
authors.lastname: Makimoto
authors.forename: Teruki
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Yuko
authors.initials: Y
authors.lastname: Yamada
authors.forename: Hideo
authors.initials: H
authors.lastname: Okamura
authors.forename: Takashi
authors.initials: T
authors.lastname: Noda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aiba
authors.forename: Naohiko
authors.initials: N
authors.lastname: Aihara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.forename: Shiro
authors.initials: S
authors.lastname: Kamakura
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D016009:Chi-Square Distribution; D017548:Echocardiography, Transesophageal; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: PVI automaticity; atrial fibrillation; catheter ablation; dissociated pulmonary vein activity; pulmonary vein isolation