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Heart rhythm disorders
Dissociated pulmonary vein potentials following antral pulmonary vein isolation for atrial fibrillation: impact on long-term outcome
  1. Geoffrey Lee1,
  2. Jonathan M Kalman1,3,
  3. Jitendra K Vohra1,
  4. Andrew Teh1,2,
  5. Caroline Medi1,2,
  6. Liang-Han Ling1,2,
  7. Peter M Kistler1,2,3,4
  1. 1Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia
  2. 2Department of Cardiology, The Alfred Hospital, Melbourne, Australia
  3. 3Department of Medicine, University of Melbourne, Melbourne, Australia
  4. 4Baker IDI Diabetes and Heart Research Institute, Melbourne, Australia
  1. Correspondence to Dr Peter M Kistler, The Heart Centre, The Alfred Hospital, Commercial Road, Melbourne 3004, Australia; peter.kistler{at}bakeridi.edu.au

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 three-dimensional 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 dPVP-positive 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.

  • Atrial fibrillation
  • radiofrequency ablation

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Footnotes

  • Funding PMK is supported by a research investigatorship from the Cardiac Society of Australia and New Zealand. GL is the recipient of a postgraduate research scholarship from the Cardiac Society of Australia and New Zealand. AT and CM are the recipients of a postgraduate research scholarship from the National Heart Foundation of Australia. AT, CM and GL are recipients of a cardiovascular and lipid research grant from Pfizer.

  • Competing interests None to declare.

  • Ethics approval This study was conducted with the approval of The Alfred Hospital Ethics Department.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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