title: Dissociated pulmonary vein activity after pulmonary vein isolation for paroxysmal atrial fibrillation: a predictor for recurrence?
abstract: BACKGROUND
  The role of dissociated pulmonary vein (DPV) activity after pulmonary vein isolation (PVI) is still poorly defined. We evaluated electrophysiological features and clinical impact on long-term outcome of DPV activity.
  
  
  METHODS
  A total of 243 patients (mean age 63 ± 11 years; 63% males) undergoing PVI for paroxysmal atrial fibrillation (AF) were included. DPV activity was defined as a residual low frequency irregular PV rhythm. Patients were divided into Group 1 (presence of DPV activity; n = 65) or Group 2 (absence of DPV activity; n = 178).
  
  
  RESULTS
  Of 936 isolated PVs, 112 PVs (12%) showed DPV activity. DPV activity was observed more frequently in PVs identified as AF triggers (P = 0.026). During follow-up (mean 12 ± 7 months), 15 of 65 patients of Group 1 (23%) and 57 of 178 patients of Group 2 (32%) had an arrhythmia recurrence (P = 0.23). At linear regression analysis, no independent predictor for clinical recurrence was identified. During the repeat ablation, 62 of 72 patients (86%) showed a recovered PV conduction without difference between the 2 groups. Clinically, all patients of Group 1 with PV reconnection (n = 13/15) had a recurrence of paroxysmal AF. In Group 2, 5 of 52 patients with reconnected PV developed non-PV related arrhythmias.
  
  
  CONCLUSIONS
  DPV activity occurred in 12% of PVs after PVI and was observed more frequently in PVs identified as AF triggers. DPV activity was not predictive for AF recurrence during follow-up. PV-left atrium reconnection involving PVs with DPV activity leads to AF.
authors.affiliation: Department for Electrophysiology, Deutsches Herzzentrum, Technische Universität München, Munich, Germany.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Buiatti
authors.forename: Sonia
authors.initials: S
authors.lastname: Ammar
authors.forename: Tilko
authors.initials: T
authors.lastname: Reents
authors.forename: Verena
authors.initials: V
authors.lastname: Semmler
authors.forename: Susanne
authors.initials: S
authors.lastname: Kathan
authors.forename: Monika
authors.initials: M
authors.lastname: Hofmann
authors.forename: Felix
authors.initials: F
authors.lastname: Bourier
authors.forename: Martha
authors.initials: M
authors.lastname: Telishevska
authors.forename: Katharina
authors.initials: K
authors.lastname: Koch-Büttner
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kaess
authors.forename: Carsten
authors.initials: C
authors.lastname: Lennerz
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
authors.forename: Gabriele
authors.initials: G
authors.lastname: Hessling
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D016009:Chi-Square Distribution; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; dissociated pulmonary vein activity; pulmonary vein isolation; recurrence