Abstract 15172: Recurrence of Atrial Fibrillation with Reconnection of Pulmonary Vein after Pulmonary Vein Isolation can be Detected Non-invasively by Vectorcardiogram
Background: Although reconnection between pulmonary vein (PV) and left atrium (LA) is associated with atrial fibrillation (AF) recurrence after PV isolation (PVI) procedure, the method for non-invasively evaluating PV reconnection remains unknown. We previously reported the significant morphological changes of the P-loop in vectorcardiogram (VCG) by loss of PV sleeve conduction by PVI. We herein investigated the correlation between AF recurrence and non-invasively detected PV-LA reconnection by reversion of the P-loop configuration in VCG.
Methods: Consecutive 38 patients (mean age: 57±9, all male) who underwent individually antral PVI for paroxysmal AF were prospectively examined. All patients were performed VCG before and after PVI, and follow-up VCG was performed 6–10 months after the procedure. The repeat PVI was performed in patients with AF recurrence, and the change in P-loop configuration was compared with electrophysiologically-proven PV-LA reconnections in the repeat procedure.
Results: All 152 PVs were successfully isolated from the LA during the initial procedure. In all patients, the middle portion of the P-loop morphology was shifted to anterolateral direction by the initial PVI. AF recurrence was observed in 12 patients (32%) who had more than 2 reconnections between the LA and PVs in the repeat procedure, and 10 patients (83%) demonstrated the P-loop reversion at AF recurrence in VCG, as shown in the Figure (A). On the other hand, in the patients without AF recurrence, the P-loop reversion was observed in only 3 patients (12%) in follow-up VCG (P < 0.01), while the others demonstrated no remarkable change, as shown in the Figure (B).
Conclusions: The change of the P-loop morphology was significantly associated with PV-LA disconnection/reconnection, VCG can be useful for non-invasively detecting AF recurrence with PV-LA reconnection after PVI.
- © 2010 by American Heart Association, Inc.