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Fibrillatory excitation in the pulmonary vein is associated with the presence of dissociated pulmonary vein activity after isolation

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Abstract

Purpose

Circumferential pulmonary vein (PV) isolation has been widely accepted for catheter ablation in patients with atrial fibrillation (AF). Dissociated PV activity might appear after PV isolation (PVI). However, little is known of dissociated PV activity. This study aimed to reveal the electrophysiological properties and clinical implications of dissociated PV activity.

Methods

The study subjects were 52 patients (62 ± 7 years, 38 men) who underwent PVI for AF. Electrophysiological properties of the left atrium (LA) and PVs during and after PVI were investigated.

Results

Out of 181 targeted PVs, 177 with successful isolation were analyzed. Dissociated PV activity appeared in 14 PVs (8 %) in 12 patients (23 %) after PVI; from the left superior PV in eight, right superior PV in five, and left inferior PV in one. The mean cycle length of dissociated PV activity was 4277 ± 2565 ms. The presence of AF prior to achieving PVI was significantly higher in PV without dissociated PV activity (105 out of 163, 64 %) than in PV with dissociated PV activity (five out of 14, 36 %, P = 0.03). The observed dissociated PV activity was enhanced (new appearance or reduced cycle length) by isoproterenol and suppressed by pacing within the isolated PV.

Conclusion

Dissociated PV activity, although influenced by uncertain factors such as overdrive suppression and autonomic situations, would be an indicator of LA-PV bidirectional block and might not be the target of additional ablation after PVI.

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Authors and Affiliations

  1. Department of Cardiology and Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Takashi Kaneshiro, Minoru Nodera, Masashi Kamioka, Yoshiyuki Kamiyama & Yasuchika Takeishi

  2. Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Hitoshi Suzuki & Yasuchika Takeishi

Authors
  1. Takashi Kaneshiro
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  2. Hitoshi Suzuki
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  3. Minoru Nodera
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  4. Masashi Kamioka
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  5. Yoshiyuki Kamiyama
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  6. Yasuchika Takeishi
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Corresponding author

Correspondence to Takashi Kaneshiro.

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The authors declare that they have no conflict of interest.

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Kaneshiro, T., Suzuki, H., Nodera, M. et al. Fibrillatory excitation in the pulmonary vein is associated with the presence of dissociated pulmonary vein activity after isolation. J Interv Card Electrophysiol 47, 231–236 (2016). https://doi.org/10.1007/s10840-016-0154-1

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  • DOI: https://doi.org/10.1007/s10840-016-0154-1

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