Identification of Pulmonary Vein Potentials by Differential Site Atrial Pacing in Patients with Paroxysmal Atrial Fibrillation:

Pulmonary vein (PV) isolation may cure paroxysmal atrial fibrillation (PAF); however, identification of PV potentials may be difficult in sinus rhythm. Studies have suggested that atrial pacing may improve the identification of PV potentials. Methods and Results: In 25 consecutive patients who underwent PV isolation for PAF, the results of pacing from the distal PV, distal and proximal coronary sinus, and high right atrium compared to sinus rhythm were analyzed to determine the most effective pacing site for identification of PV potentials. The percentage of confirmed PV potentials and the longest interval between atrial and PV potentials in each PV were compared during differential site pacing and sinus rhythm. PV potentials were confirmed in 63 (82%) of 77 PVs that could be mapped during the complete pacing protocol and during sinus rhythm. Distal PV pacing identified significantly more PV potentials (left upper pulmonary vein [LUPV] 100%, left lower pulmonary vein [LLPV] 84%, right upper pulmonary vein [RUPV] 80%, right lower pulmonary vein [RLPV] 53%) compared to other pacing sites and sinus rhythm. Among atrial pacing sites, those ipsilateral to the PV being mapped were the most effective for identifying PV potentials. The intervals between atrial and PV potentials were significantly longer during distal PV pacing than pacing at other sites (LUPV 81.6 ± 26.2 ms, LLPV 61.4 ± 26.1 ms, RUPV 59.7 ± 33.2 ms, RLPV 39.7 ± 26.7 ms). Conclusion: (1) Distal PV pacing was most effective for identifying PV potentials. (2) The interval between atrial and PV potentials was longest during distal PV pacing. (J Cardiovasc Electrophysiol, Vol. 14, pp. 1311‐1318, December 2003)