Mechanism of Immediate Recurrences of Atrial Fibrillation after Restoration of Sinus Rhythm

Aman Chugh, Mehmet Ozaydin, Christoph Scharf, Steve W K Lai, Burr Hall, Peter Cheung, Frank Pelosi, Bradley P. Knight, Fred Morady, Hakan Oral*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

An immediate recurrence of AF may occur after restoration of sinus rhythm. Although pulmonary vein (PV) isolation has been shown to prevent immediate recurrence of AF, the specific trigger for immediate recurrence of AF has not been described. In 89 consecutive patients (mean age 53 ± 11 years) who had sinus rhythm restored by spontaneous or transthoracic cardioversion in the course of a PV isolation procedure, electrograms recorded within a PV and in the adjacent left atrium were analyzed to determine the mechanism of initiation of immediate recurrence of AF. Immediate recurrence of AF was defined as a recurrence of AF within 90 seconds after restoration of sinus rhythm. There were 124 episodes of immediate recurrence of AF at a mean of 18 ± 23 seconds after cardioversion. Recordings within the PV that triggered the immediate recurrence of AF were available in 23 (19%) of the 124 immediate recurrence of AF episodes. Among these 23 episodes of immediate recurrence of AF, all (100%) were triggered by a burst of PV tachycardia (P < 0.001). The coupling interval and prematurity index (coupling interval/preceding sinus cycle length) of the premature depolarizations that did and did not trigger immediate recurrence of AF were 246 ± 67 ms and 0.30 ± 0.11 vs 378 ± 117 ms and 0.49 ± 0.16, respectively (P < 0.01). Immediate recurrence of AF was abolished by PV isolation. The mechanism of immediate recurrence of AF is a burst of PV tachycardia, not a single premature depolarization. Immediate recurrence of AF identifies patients with AF in whom the PVs may play a major role in the initiation of AF.

Original languageEnglish (US)
Pages (from-to)77-82
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Volume27
Issue number1
DOIs
StatePublished - Jan 1 2004

Keywords

  • Atrial fibrillation
  • Cardioversion
  • Pulmonary vein

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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