Mechanistic significance of intermittent pulmonary vein tachycardia in patients with atrial fibrillation

Hakan Oral*, Mehmet Özaydin, Hiroshi Tada, Aman Chugh, Christoph Scharf, Sohail Hassan, Steve Lai, Radmira Greenstein, Frank Pelosi, Bradley P. Knight, S. Adam Strickberger, Fred Morady

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

177 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)645-650
Number of pages6
JournalJournal of cardiovascular electrophysiology
Volume13
Issue number7
DOIs
StatePublished - 2002

Keywords

  • Atrial fibrillation
  • Pulmonary vein
  • Radiofrequency catheter ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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