Distinctive Electrophysiological Properties of Pulmonary Veins in Patients With Atrial Fibrillation

Abstract

Background-Atrial fibrillation (AF) is frequently initiated from pulmonary veins (PVs), but little is known of the electrophysiological properties of PVs. Methods and Results-Two groups were studied: 28 patients (49Ϯ13 years old) with paroxysmal AF and 20 control patients (49Ϯ14 years old) without AF. Effective and functional refractory period and conduction time from PV to left atrium (LA) were compared in the 2 groups by use of programmed stimulation with a single extrastimulus in the PVs and LA. In the AF group, the venous effective refractory periods (ERPs) were shorter than that of the LA: 185Ϯ71 versus 253Ϯ21 ms, PϽ0.001, whereas in the control group, they were longer (282Ϯ45 versus 253Ϯ41 ms, Pϭ0.009).The venous ERPs and functional refractory periods in patients with AF were also shorter than that observed in control subjects (185Ϯ71 versus 282Ϯ45 ms and 210Ϯ77 versus 315Ϯ43 ms, respectively, PϽ0.001), whereas LA ERPs were not significantly different. Decremental conduction in PVs was more frequent (93% versus 56%, Pϭ0.01) and had a greater increment (102Ϯ65 versus 42Ϯ40 ms, PϽ0.001) in patients with AF. Finally, AF was more frequently induced when pacing was performed in PVs (

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…Accordingly, rapid reentrant activity with entrainment phenomena have been described inside PVs after successful PV isolation (PVI). 95,96 Electrophysiological evaluation of the PVs using multielectrode basket catheters has revealed effective refractory period (ERP) heterogeneity and anisotropic conduction properties within the PV and at the PV–LA junction, which can provide a substrate for reentry. 97 The response of PV activity to adenosine administration in patients with PAF is more consistent with a reentrant than a focalectopic type of mechanism.…”

History of hyperthyroidism and long-term outcome of catheter ablation of drug-refractory atrial fibrillation

“…The PV is important source for AF initiation and it plays critical roles in AF maintenance. 23,24 We demonstrated a higher number of PV ectopies in patients with history of hyperthyroidism compared to the normal thyroid patients. Several mechanisms of increased PV arrhythmogenicity in hyperthyroidism have been proposed.…”

Recent Trends in Minimally Invasive Cardiac Surgery

“…As a result, alternative, less invasive methods have been sought to perform surgery for AF. As our understanding of AF evolves, it is evident that a certain population of patients with AF can be successfully treated with more limited procedures aimed at the electrical isolation of discrete atrial regions, including the pulmonary veins [39]. …”