Fibrillatory pattern of dissociated venous activity after pulmonary vein isolation: Novel characteristics for remnant foci of a trigger ectopy for atrial fibrillation.
BACKGROUND
Dissociated pulmonary vein activity (DPVA), defined as isolated intrinsic ectopic beats observed after successful pulmonary vein (PV) isolation, indicates the presence of remnant foci of trigger ectopy but has yet to be extensively studied. We investigated the correlation between DPVA and the PV triggers of atrial fibrillation (AF).


RESULTS
Consecutive 110 patients undergoing AF ablation were enrolled. We defined trigger ectopy as documented ectopic foci observed to spontaneously initiate AF. Trigger ectopy was detected in 62 (56%) patients. DPVA in at least one PV was detected in 95 (86%) patients. Of the 440 isolated PVs, we recognized trigger ectopy in 73 (16%) PVs (culprit PVs) and DPVA in 184 (42%) PVs. DPVA was more frequently observed in culprit PVs than in non-culprit PVs [59% vs. 39%; odds ratio (OR)=2.3; p=0.001]. The concordance ratio of culprit PV was 67% (8/12) in PV with fibrillatory DPVA, 20% (35/172) in PV with non-fibrillatory DPVA, and 12% (30/256) in PV without DPVA. Fibrillatory DPVA was more frequently observed in culprit PVs than non-fibrillatory DPVA (OR=7.8; p=0.001). Non-PV foci were observed in 10 (11%) of the 95 patients with DPVA and 5 (33%) of the 15 patients without DPVA (OR=4.3; p=0.02). No significant difference in the frequency of AF recurrence was observed between them.


CONCLUSIONS
Fibrillatory DPVA was found to be strongly associated with trigger ectopy of AF. Non-fibrillatory DPVA might merely indicate the existence of bystander ectopic foci located inside PVs. Non-PV ectopic foci were frequently observed in patients without DPVA.
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Masato
M
Okada
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Akio
A
Hirata
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Kazunori
K
Kashiwase
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Yasuharu
Y
Takeda
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Takayoshi
T
Nemoto
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Koshi
K
Matsuo
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Keisuke
K
Ueno
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Yuji
Y
Nishimoto
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Ryuta
R
Sugihara
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Ayaka
A
Murakami
Cardiovascular Division, Osaka National Hospital, Osaka, Japan. Electronic address: yellowplaque@gmail.com.
Yasunori
Y
Ueda
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Yoshio
Y
Yasumura
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome
Atrial fibrillation; Catheter ablation; Dissociated pulmonary vein activity; Pulmonary vein isolation