title: Marked suppression of pulmonary vein firing after circumferential pulmonary vein isolation in patients with paroxysmal atrial fibrillation: is pulmonary vein firing an epiphenomenon?
abstract: BACKGROUND
  Rapid firing in pulmonary veins (PVs) is a leading cause of paroxysmal atrial fibrillation. We hypothesized that PV firing (PV-F) should continue after circumferential PV isolation (CPVI) because the PV tissue responsible for PV-F remains intact.
  
  
  RESULTS
  In Group-1 (n = 92), isoproterenol (ISP) and adenosine triphosphate (ATP) were co-administered to provoke PV-F before and after CPVI. The site of rapid focal discharge that initiated atrial fibrillation (AF) defined PV-F versus non-PV-F. Additional 17 patients with PV-F induced by ISP+ATP before CPVI were enrolled into Group-2 and various pacing maneuvers were used in conjunction to ISP+ATP to provoke PV-F after CPVI. In Group-1, AF was induced in 47/81 (58.0%) and 16/88 (18.2%) patients before and after CPVI, respectively (P < 0.01). Before CPVI, 43/47 (91.5%) of the rapid firing originated from PV. After successful CPVI, 88/92 patients were in sinus rhythm and non-PV-F was induced in 14/88 patients. PV-F was induced in 2/88 patients, which was eliminated by ganglionated plexus ablation outside the CPVI line. In Group-2, various pacing maneuvers with ISP+ATP only induced PV-F in 1/17 patients after CPVI.
  
  
  CONCLUSIONS
  Marked suppression of PV-F after CPVI strongly suggests that the real source of PV-F is located in the atrium. PV-F may be an epiphenomenon.
authors.affiliation: Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China.
authors.forename: Ru-Hong
authors.initials: RH
authors.lastname: Jiang
authors.forename: Chen-Yang
authors.initials: CY
authors.lastname: Jiang
authors.forename: Xia
authors.initials: X
authors.lastname: Sheng
authors.forename: Zu-Wen
authors.initials: ZW
authors.lastname: Zhang
authors.forename: Ya-Xun
authors.initials: YX
authors.lastname: Sun
authors.forename: Qiang
authors.initials: Q
authors.lastname: Liu
authors.forename: Guo-Sheng
authors.initials: GS
authors.lastname: Fu
authors.forename: Sunny S
authors.initials: SS
authors.lastname: Po
mesh_terms: D000200:Action Potentials; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology*; D016896:Treatment Outcome
keywords: atrial fibrillation; autonomic nervous system; catheter ablation; pulmonary vein isolaton; vagus