Address for correspondence: Yoshihide Takahashi, M.D., 11-7 Manabeshin-machi, Tsuchiura-shi, Ibaraki-ken, 300-0053 Japan. Fax: 81298262411; E-mail: [email protected]

Manuscript received 3 March 2003; Accepted for publication 4 June 2003.

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Abstract

Introduction: Although slow automatic pulmonary vein (PV) activity dissociated from the atrium after achievement of PV isolation in patients with atrial fibrillation (AF) has been reported, little is known about dissociated PV tachycardia. The aim of this study was to investigate the inducibility and the mechanism of sustained PV tachycardia (SPVT).

Methods and Results: One hundred thirty-two patients with drug-refractory paroxysmal AF underwent PV isolation by radiofrequency catheter ablation. Programmed stimulation was performed in 269 PVs of 110 of these patients after achievement of PV isolation. In 7 PVs (2.6%; left superior PV: n = 2, right superior PV: n = 4, right inferior PV: n = 1) of 7 (6.4%) of 110 patients, 18 SPVTs were induced. Fifteen regular SPVTs (mean cycle length 152 ± 34 msec) were induced in 6 of 7 PVs, and 3 irregular SPVTs (cycle length range: 94–276 msec) were induced in 3 of 7 PVs. In 2 PVs, both regular and irregular SPVTs were induced. SPVT was terminated by burst pacing in 4 PVs, and entrainment was observed during regular SPVT in 5 PVs. Slow PV automatic activity dissociated from the atrium and decremental conduction properties were shown in all 7 PVs. The shortest pacing cycle length with 1:1 capture was ≤150 msec in 6 of 7 PVs.

Conclusion: Reentrant tachycardia can occur in some isolated PVs with both decremental conduction properties and short refractory periods, which suggests that reentry may be one of the mechanisms of PV arrhythmogenicity. (J Cardiovasc Electrophysiol, Vol. 14, pp. 927-932, September 2003)

References

1 Haissaguerre M, Jais P, Shah D, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Metayer P, Clementy J: Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659-666.
10.1056/NEJM199809033391003
CAS PubMed Web of Science® Google Scholar
2 Chen SA, Hsieh MH, Tai CT, Tsai CF, Prakash VS, Yu WC, Hsu TL, Ding YA, Chang MS: Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation 1999; 100: 1879-1886.
10.1161/01.CIR.100.18.1879
CAS PubMed Web of Science® Google Scholar
3 Haissaguerre M, Jais P, Shah D, Garrigue S, Takahashi A, Lavergne T, Hocini M, Peng JT, Roudaut R, Clementy J: Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation 2000; 101: 1409-1417.
10.1161/01.CIR.101.12.1409
CAS PubMed Web of Science® Google Scholar
4 Haissaguerre M, Shah D, Jais P, Hocini M, Yamane T, Deisenhofer I, Chauvin M, Garrigue S, Clementy J: Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation 2000; 102: 2463-2465.
10.1161/01.CIR.102.20.2463
CAS PubMed Web of Science® Google Scholar
5 Takahashi A, Iesaka Y, Takahashi Y, Takahashi R, Kobayashi K, Takagi K, Kuboyama O, Nishimori T, Takei H, Amemiya H, Fuijwara H, Hiraoka M: Electrical connections between pulmonary veins: Implication for ostial ablation of pulmonary veins in patients with paroxysmal atrial fibrillation. Circulation 2002; 105: 2998-3003.
10.1161/01.CIR.0000019585.91146.AB
PubMed Web of Science® Google Scholar
6 Waldo AL, Plumb VJ, Arciniegas JG, MacLean WAH, Cooper TB, Priest MF, James TN: Transient entrainment and interruption of the atrioventricular bypass pathway type of paroxysmal atrial tachycardia: A model for understanding and identifying reentrant arrhythmias. Circulation 1983; 67: 73-83.
10.1161/01.CIR.67.1.73
CAS PubMed Web of Science® Google Scholar
7 Henthorn RW, Okumura K, Olshansky B, Plumb VJ, Hess PG, Waldo AL: A fourth criterion for transient entrainment: the electrogram equivalent of progressive fusion. Circulation 1988; 77: 1003-1012.
10.1161/01.CIR.77.5.1003
CAS PubMed Web of Science® Google Scholar
8 Pappone C, Oreto G, Rosanio S, Vicedomini G, Tocchi M, Gugliotta F, Salvati A, Dicandia C, Calabro M, Mazzone P, Ficarra E, Di Gioia C, Gulletta S, Nardi S, Santinelli V, Benussi S, Alfieri O: Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001; 104: 2539-2544.
10.1161/hc4601.098517
CAS PubMed Web of Science® Google Scholar
9 Oral H, Knight BP, Tada H, Ozaydin H, Chugh A, Hassan S, Scharf C, Lai SW, Greenstein R, Pelosi F Jr, Strickberger SA, Morady F: Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 2002; 105: 1077-1081.
10.1161/hc0902.104712
PubMed Web of Science® Google Scholar
10 Sueda T, Imai K, Ishii O, Orihashi K, Watari M, Okada K: Efficacy of pulmonary vein isolation for the elimination of chronic atrial fibrillation in cardiac valvular surgery. Ann Thorac Surg 2001; 71: 1189-1193.
10.1016/S0003-4975(00)02606-0
CAS PubMed Web of Science® Google Scholar
11 Pappone C, Rosanio S, Oreto G, Tocchi M, Gugliotta F, Vicedomini G, Salvati A, Dicandia C, Mazzone P, Santinelli V, Gulletta S, Chierchia S: Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation. Circulation 2000; 102: 2619-2628.
10.1111/j.1540-8167.2007.00981.x
CAS PubMed Web of Science® Google Scholar
12 Oral H, Knight BP, Ozaydin H, Chugh A, Lai SW, Scharf C, Hassan S, Greenstein R, Han JD, Pelosi F Jr, Strickberger SA, Morady F: Segmental ostial ablation to isolate the pulmonary veins during atrial fibrillation: feasibility and mechanistic insights. Circulation. 2002; 106: 1256-1262.
10.1161/01.CIR.0000027821.55835.00
PubMed Web of Science® Google Scholar
13 Oral H, Ozaydin H, Tada H, Chugh A, Scharf C, Hassan S, Lai S, Greenstein R, Pelosi Jr. F, Knight BP, Strickberger SA, Morady F: Mechanistic significance of intermittent pulmonary vein tachycardia in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2002; 13: 645-650.
10.1046/j.1540-8167.2002.00645.x
PubMed Web of Science® Google Scholar
14 Chen YJ, Chen SA, Chang MS, Lin CI: Arrhythmogenic activity of cardiac muscle in pulmonary veins of the dog: implication for the genesis of atrial fibrillation. Cardiovasc Res 2000; 48: 265-273.
10.1016/S0008-6363(00)00179-6
CAS PubMed Web of Science® Google Scholar
15 Hocini M, Ho SY, Kawara T, Linnenbank AC, Potse M, Shah DC, Jais P, Jense MJ, Haissaguerre M, De Bakker JM: Electrical conduction in canine pulmonary veins: Electrophysiological and anatomic correlation. Circulation 2002; 106: 2442-2448.
10.1161/01.CIR.0000016062.80020.11
PubMed Web of Science® Google Scholar
16 Jais P, Hocini M, Macle L, Choi KJ, Deisenhofer I, Weerasooriya R, Shah DC, Garrigue S, Raybaud F, Scavee C, Le Metayer P, Clementy J, Haissaguerre M: Distinctive electrophysiological properties of pulmonary veins in patients with atrial fibrillation. Circulation 2002; 106: 2479-2485.
10.1161/01.CIR.0000036744.39782.9F
PubMed Web of Science® Google Scholar
17 Blom NA, Gittenberger-de Groot AC, DeRuiter MC, Poelmann RE, Mentink MM, Ottenkamp J: Development of the cardiac conduction tissue in human embryos using HNK-1 antigen expression: Possible relevance for understanding of abnormal atrial automaticity. Circulation 1999; 99: 800-806.
10.1161/01.CIR.99.6.800
CAS PubMed Web of Science® Google Scholar
18 Weiss C, Gocht A, Willems S, Hoffmann M, Risius T, Meinertz T: Impact of the distribution and structure of myocardium in the pulmonary veins for radiofrequency ablation of atrial fibrillation. Pacing Clin Electrophysiol 2002; 25: 1352-1356.
10.1046/j.1460-9592.2002.01352.x
PubMed Web of Science® Google Scholar
19 Chorro FJ, Sanchis J, Such L, Garcia-Civera R, Llavador E, Mainar L, Canoves J, Egea S, Cerda M, Lopez-Merino V: Acute effects of radiofrequency ablation upon atrial conduction in proximity to the lesion site. Pacing Clin Electrophysiol 1998; 21(Pt. I): 659-668.
10.1111/j.1540-8159.1998.tb00121.x
CAS PubMed Web of Science® Google Scholar
20 Wood MA, Fuller IA: Acute and chronic electrophysiologic changes surrounding radiofrequency lesions. J Cardiovasc Electrophysiol 2002; 13: 56-61.
10.1046/j.1540-8167.2002.00056.x
PubMed Web of Science® Google Scholar

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Volume14, Issue9

September 2003

Pages 927-932

Reentrant Tachycardia in Pulmonary Veins of Patients with Paroxysmal Atrial Fibrillation

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Reentrant Tachycardia in Pulmonary Veins of Patients with Paroxysmal Atrial Fibrillation

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