TY - JOUR
T1 - Mechanistic significance of intermittent pulmonary vein tachycardia in patients with atrial fibrillation
AU - Oral, Hakan
AU - Özaydin, Mehmet
AU - Tada, Hiroshi
AU - Chugh, Aman
AU - Scharf, Christoph
AU - Hassan, Sohail
AU - Lai, Steve
AU - Greenstein, Radmira
AU - Pelosi, Frank
AU - Knight, Bradley P.
AU - Strickberger, S. Adam
AU - Morady, Fred
PY - 2002
Y1 - 2002
N2 - Introduction: The significance of intermittent tachycardia within a pulmonary vein (PV) during an episode of atrial fibrillation (AF) is unclear. The aim of this study was to determine the role that intermittent PV tachycardias play in AF. Methods and Results: In 56 patients with AF, segmental ostial ablation guided by PV potentials was performed to isolate the PVs. The characteristics of intermittent PV tachycardias and the inducibility of AF before and after PV isolation were analyzed prospectively. During AF, a PV tachycardia (mean cycle length 130 ± 30 msec) with exit block to the left atrium was present in 93% of left superior, 80% of left inferior, 73% of right superior, and 7% of right inferior PVs. The site of shortest cycle length during AF alternated between the PVs and left atrium 1 to 13 times per minute. Complete isolation was achieved in 168 (94%) of 178 targeted PVs. In 99% of PVs, tachycardia resolved upon isolation. AF was persistent before and after PV isolation in 100% and 27% of patients, respectively (P < 0.001). Conclusion: Intermittent bursts of tachycardia are observed within multiple PVs during persistent AF in a majority of patients. After PV isolation, PV tachycardias almost always resolve, and AF is less likely to be inducible or persistent. These observations suggest a dynamic interplay between the atria and PVs, with intermittent bursts of PV tachycardia being dependent on left atrial input and with the probability of persistent AF diminishing when PV tachycardias are eliminated by PV isolation.
AB - Introduction: The significance of intermittent tachycardia within a pulmonary vein (PV) during an episode of atrial fibrillation (AF) is unclear. The aim of this study was to determine the role that intermittent PV tachycardias play in AF. Methods and Results: In 56 patients with AF, segmental ostial ablation guided by PV potentials was performed to isolate the PVs. The characteristics of intermittent PV tachycardias and the inducibility of AF before and after PV isolation were analyzed prospectively. During AF, a PV tachycardia (mean cycle length 130 ± 30 msec) with exit block to the left atrium was present in 93% of left superior, 80% of left inferior, 73% of right superior, and 7% of right inferior PVs. The site of shortest cycle length during AF alternated between the PVs and left atrium 1 to 13 times per minute. Complete isolation was achieved in 168 (94%) of 178 targeted PVs. In 99% of PVs, tachycardia resolved upon isolation. AF was persistent before and after PV isolation in 100% and 27% of patients, respectively (P < 0.001). Conclusion: Intermittent bursts of tachycardia are observed within multiple PVs during persistent AF in a majority of patients. After PV isolation, PV tachycardias almost always resolve, and AF is less likely to be inducible or persistent. These observations suggest a dynamic interplay between the atria and PVs, with intermittent bursts of PV tachycardia being dependent on left atrial input and with the probability of persistent AF diminishing when PV tachycardias are eliminated by PV isolation.
KW - Atrial fibrillation
KW - Pulmonary vein
KW - Radiofrequency catheter ablation
UR - http://www.scopus.com/inward/record.url?scp=0035996715&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0035996715&partnerID=8YFLogxK
U2 - 10.1046/j.1540-8167.2002.00645.x
DO - 10.1046/j.1540-8167.2002.00645.x
M3 - Article
C2 - 12139285
AN - SCOPUS:0035996715
SN - 1045-3873
VL - 13
SP - 645
EP - 650
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 7
ER -