Dissociated pulmonary vein potentials following antral pulmonary vein isolation for atrial fibrillation: Impact on long-term outcome

Geoffrey Lee, Jonathan M. Kalman, Jitendra K. Vohra, Andrew Teh, Caroline Medi, Liang Han Ling, Peter M Kistler

Research output: Contribution to journalArticleResearchpeer-review

19 Citations (Scopus)

Abstract

Background: Pulmonary vein (PV) reconnection is the Achilles heel of pulmonary vein isolation (PVI) for atrial fibrillation (AF). Dissociated pulmonary vein potentials (dPVP) may reflect abnormal PV automaticity, indicate more extensive PV muscular sleeve or may simply be an epiphenomenon. Objective: This study sought to determine the incidence, characteristics and prognostic significance of dPVP following PVI for AF. Methods: 89 consecutive patients (mean age 58.2±8.4 years, 75% male, 74% paroxysmal, 26% persistent AF) underwent antral PVI using threedimensional mapping systems with image integration with the endpoint of bidirectional PV block. Following PV electrical isolation the presence and characteristics of dPVP were recorded. Holter monitoring was performed at 3, 6 and 12 months. Acute PV reconnection was assessed over a 30-min waiting period. Results: Electrical isolation was achieved in all 372 PV targeted for ablation. 69 of 372 isolated PV (19%) demonstrated dPVP after acute electrical isolation. Sites of dPVP origin were the left superior in 36%, left inferior in 20%, right superior in 31% and right inferior in 12%. All 69 dPVP demonstrated slow activity (cycle length >1500 ms) with only four persisting more than 30 min after acute isolation. There was no difference in the clinical characteristics between dPVP-positive vs dPVP-negative patients. At a mean follow-up of 21±8 months the single procedure success was 25/33 (76%) in dPVPpositive versus 39/60 (64%) in dPVP-negative patients (p=-0.3). In the eight dPVP-positive patients who underwent a second procedure, 11 of the 14 (79%) veins with initial dPVP demonstrated PV - left atrial reconnection. Conclusion: dPVP are present in 19% of PV following acute antral electrical isolation. The presence of dPVP did not predict recurrent AF following PVI.

Original languageEnglish
Pages (from-to)579-584
Number of pages6
JournalHeart
Volume97
Issue number7
DOIs
Publication statusPublished - Apr 2011
Externally publishedYes

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