Association between dissociated firing in isolated pulmonary veins and the initiation and maintenance of atrial fibrillation

Background Whether dissociated firing (DiFi) in isolated pulmonary veins (PVs) implies arrhythmogenicity of the particular PV and, therefore, a better outcome of PV isolation (PVI) for paroxysmal atrial fibrillation (PAF) is debated. Methods Thirty-one patients undergoing their first PVI for PAF wer...

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Published in:Journal of interventional cardiac electrophysiology 2016-01, Vol.45 (1), p.29-35
Main Authors: Tutuianu, Cristina, Traykov, Vassil, Bencsik, Gábor, Klausz, Gergely, Sághy, László, Pap, Robert
Format: Article
Language:English
Subjects:
Action Potentials
Atrial Fibrillation - physiopathology
Biological Clocks
Cardiology
Chronic Disease
Electrocardiography - drug effects
Electrocardiography - methods
Female
Heart Conduction System - drug effects
Heart Conduction System - physiopathology
Humans
Isoproterenol - administration & dosage
Male
Medicine
Medicine & Public Health
Middle Aged
Models, Cardiovascular
Pulmonary Veins - drug effects
Pulmonary Veins - physiopathology
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Summary:Background Whether dissociated firing (DiFi) in isolated pulmonary veins (PVs) implies arrhythmogenicity of the particular PV and, therefore, a better outcome of PV isolation (PVI) for paroxysmal atrial fibrillation (PAF) is debated. Methods Thirty-one patients undergoing their first PVI for PAF were studied. Isoproterenol was infused for induction, and the triggering PV was identified. During sustained PAF, sequential recordings were made with a decapolar circular mapping catheter from each PV. The dominant frequency (DF) was determined using fast Fourier transformation. Spontaneous DiFi was monitored for 30 min after PVI. Results PAF was triggered by the PVs in all patients. Fourteen (45 %) patients had DiFi after PVI in at least one PV. It was recorded most commonly from the left upper (84 %) and lower (67 %), less commonly from the right upper (31 %) PV. Out of the 23 PVs with DiFi, 13 (57 %) showed sporadic ectopic beats while 10 (44 %) had sustained ectopic rhythm or isolated tachycardia. There was no difference in size between PVs with or without DiFi (5.9 ± 1.2 vs. 5.6 ± 1.0 cm ostial perimeter, p  = 0.40). Triggering PVs more commonly showed any DiFi, compared to nontriggering PVs (68 vs. 27 %, p  = 0.003) and more commonly had sustained DiFi (53 vs. 0 %, p  
ISSN:1383-875X
1572-8595
DOI:10.1007/s10840-015-0070-9