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The Effects of Pulmonary Vein Isolation on the Dominant Frequency and Organization of Coronary Sinus Electrical Activity During Permanent Atrial Fibrillation
Author(s) -
RAZAVI MEHDI,
ZHANG SHULONG,
DELAPASSE SCOTT,
YANG DONGHUI,
AI TOMOHIKO,
KAR BISWAJIT,
YOUNIS GEORGE,
RASEKH ABDI,
CHENG JIE
Publication year - 2006
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2006.00524.x
Subject(s) - medicine , pulmonary vein , atrial fibrillation , cardiology , coronary sinus , sinus rhythm , ablation , catheter ablation , atrium (architecture)
Background: Pulmonary vein isolation (PVI) has been shown to suppress atrial fibrillation (AF). We examined the effects of PVI on disorganization and dominant frequencies (DF) in patients with permanent AF.Methods and results: Twenty‐eight patients with permanent AF (>6 months) who failed ≥1 antiarrhythmic drugs (AAD) and ≥2 cardioversions (CV) with AF reversion <30 minutes after CV were included. PVI and isolation of DFs in pulmonary veins (PVs) was performed during AF. Fast Fourier transformations of atrial electrograms were performed. Disorganization index (DI) was defined as the percentage of time spent in type III AF during 1‐minute continuous recordings. The temporal stability and reproducibility of DIs from the same sites were verified over time prior to ablation. Highly disorganized AF activity concentrated in the posterior left atrium (PLA) including sites at the left atrial (PV‐LA) junction (55.7% of sites in PLA, 32.9% in septum, and 11.4% in other sites). DF and DI from the coronary sinus (CS) before and after PVI were analyzed. PVI reduced the DI (14.3 ± 25.0% before PVI vs 4.6 ± 8.6% after PVI; P < 0.02). There was significant reduction of DI in 26 of 28 patients. The DF remained unchanged (5.6 ± 1.3 Hz before PVI vs 5.9 ± 0.9 Hz after PVI; P = 0.31). After a follow‐up of 30 ± 11 months, 15 (54%) of patients are free of symptomatic AF, 3 (10%) in sinus rhythm on AAD, 5 (18%) with paroxysmal AF, 4 (14%) in chronic AF, and 1 (4%) with atypical flutter.Conclusions: In the vast majority of patients with chronic AF, PVI reduces AF disorganization without affecting the DF as measured in the CS.