Fibrillatory excitation in the pulmonary vein is associated with the presence of dissociated pulmonary vein activity after isolation.
OBJECTIVE
Circumferential pulmonary vein (PV) isolation has been widely accepted for catheter ablation in patients with atrial fibrillation (AF). Dissociated PV activity might appear after PV isolation (PVI). However, little is known of dissociated PV activity. This study aimed to reveal the electrophysiological properties and clinical implications of dissociated PV activity.


METHODS
The study subjects were 52 patients (62 ± 7 years, 38 men) who underwent PVI for AF. Electrophysiological properties of the left atrium (LA) and PVs during and after PVI were investigated.


RESULTS
Out of 181 targeted PVs, 177 with successful isolation were analyzed. Dissociated PV activity appeared in 14 PVs (8 %) in 12 patients (23 %) after PVI; from the left superior PV in eight, right superior PV in five, and left inferior PV in one. The mean cycle length of dissociated PV activity was 4277 ± 2565 ms. The presence of AF prior to achieving PVI was significantly higher in PV without dissociated PV activity (105 out of 163, 64 %) than in PV with dissociated PV activity (five out of 14, 36 %, P = 0.03). The observed dissociated PV activity was enhanced (new appearance or reduced cycle length) by isoproterenol and suppressed by pacing within the isolated PV.


CONCLUSIONS
Dissociated PV activity, although influenced by uncertain factors such as overdrive suppression and autonomic situations, would be an indicator of LA-PV bidirectional block and might not be the target of additional ablation after PVI.
Department of Cardiology and Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan. tk2435@fmu.ac.jp.
Takashi
T
Kaneshiro
Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
Hitoshi
H
Suzuki
Department of Cardiology and Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
Minoru
M
Nodera
Department of Cardiology and Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
Masashi
M
Kamioka
Department of Cardiology and Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
Yoshiyuki
Y
Kamiyama
Department of Cardiology and Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.|Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
Yasuchika
Y
Takeishi
D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006327:Heart Block / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology*; D012008:Recurrence; D016896:Treatment Outcome
Atrial fibrillation; Dissociated pulmonary vein activity; Pulmonary vein isolation