Abstract 18494: Effect of Circumferential Pulmonary Vein Isolation on the Dominant Frequency in the Contralateral Pulmonary Vein during Atrial Fibrillation
Introduction: The interaction of the electrical activities among the pulmonary veins (PVs) during atrial fibrillation (AF) is unclear. To define this, we examined how circumferential isolation (CPVI) of one-side PV influences to DF in the contralateral PV.
Methods: The consecutive 46 patients (33 men; mean age, 60±12 years; 36 with paroxysmal AF) with induced or spontaneous sustained AF undergoing CPVI were studied. These patients were divided into two groups depending on which side PVs were isolated at the beginning of the procedure. In group A (n=34), CPVI was performed in the right side PVs at the beginning. In group B (n=12), CPVI was performed in the left side PVs at the beginning. CPVI in the right (or left) side PVs was performed while continuously recording 10 bipolar electrograms in the left (or right) superior PV using a circular catheter and 5 bipolar electrograms in the CS. Before and after right (or left) side CPVI, DF for a 30-second period was determined in each electrogram, and mean DFs in left (or right) superior PV and CS were calculated. There were no significant differences between 2 groups in the gender, age, and echocardiographic findings, except for prevalence of paroxysmal AF (24/34 (71%) in Group A vs 12/12 (100%) in Group B, p<0.05)
Results: In group A, the baseline DFs in left superior PV were significantly higher than that in CS (6.3±0.9 Hz vs. 5.4±0.7 Hz, p<0.01). AF was not terminated by the right side CPVI in any patients, but mean DFs in left superior PV and CS were significantly decreased from 6.3±0.9 to 5.7±0.7 Hz (p<0.01) and 5.4±0.7 to 5.2±0.7 Hz (p<0.01), respectively. The degree of DF decrease in left superior PV was significantly greater than that in CS (0.6±0.5 Hz vs 0.3±0.30 Hz, p<0.01). In group B, mean DFs in right superior PV and CS were significantly decreased from 6.1±1.2 to 5.4±0.5 Hz (p<0.05) and 5.5±0.7 to 5.3±0.7 Hz (p<0.05), respectively. There was no significant difference between right superior PV and CS in the degree of DF decrease. (0.7±0.9 Hz vs 0.2±0.3 Hz, p=NS). The following contralateral CPVI terminated AF in 35 patients (76%).
Conclusions: There is a significant interaction between the electrical activities in the right and left PVs during AF. This may be one of the mechanisms relating to the persistence of AF.
Author Disclosures: D. Horiuchi: None.
- © 2014 by American Heart Association, Inc.