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Marked Suppression of Pulmonary Vein Firing After Circumferential Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation: Is Pulmonary Vein Firing an Epiphenomenon?
Author(s) -
JIANG RUHONG,
JIANG CHENYANG,
SHENG XIA,
ZHANG ZUWEN,
SUN YAXUN,
LIU QIANG,
FU GUOSHENG,
PO SUNNY S.
Publication year - 2014
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12288
Subject(s) - medicine , pulmonary vein , cardiology , atrial fibrillation , ablation , catheter ablation , paroxysmal atrial fibrillation , sinus rhythm , radiofrequency ablation , vein
Is Pulmonary Vein Firing an Epiphenomenon? Introduction Rapid firing in pulmonary veins (PVs) is a leading cause of paroxysmal atrial fibrillation. We hypothesized that PV firing (PV‐F) should continue after circumferential PV isolation (CPVI) because the PV tissue responsible for PV‐F remains intact. Methods and Results In Group‐1 (n = 92), isoproterenol (ISP) and adenosine triphosphate (ATP) were co‐administered to provoke PV‐F before and after CPVI. The site of rapid focal discharge that initiated atrial fibrillation (AF) defined PV‐F versus non‐PV‐F. Additional 17 patients with PV‐F induced by ISP+ATP before CPVI were enrolled into Group‐2 and various pacing maneuvers were used in conjunction to ISP+ATP to provoke PV‐F after CPVI. In Group‐1, AF was induced in 47/81 (58.0%) and 16/88 (18.2%) patients before and after CPVI, respectively (P < 0.01). Before CPVI, 43/47 (91.5%) of the rapid firing originated from PV. After successful CPVI, 88/92 patients were in sinus rhythm and non‐PV‐F was induced in 14/88 patients. PV‐F was induced in 2/88 patients, which was eliminated by ganglionated plexus ablation outside the CPVI line. In Group‐2, various pacing maneuvers with ISP+ATP only induced PV‐F in 1/17 patients after CPVI. Conclusion Marked suppression of PV‐F after CPVI strongly suggests that the real source of PV‐F is located in the atrium. PV‐F may be an epiphenomenon.