Document Detail


Effect of pulmonary vein isolation on the left-to-right atrial dominant frequency gradient in human atrial fibrillation.
MedLine Citation:
PMID:  16876735     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We previously demonstrated the existence of a left-to-right atrial dominant frequency gradient during paroxysmal but not persistent atrial fibrillation (AF) in humans. One possible mechanism of the left-to-right dominant frequency gradient involves the role of the pulmonary veins (PVs) in AF maintenance. OBJECTIVES: The purpose of this study was to examine the effect of PV isolation on the dominant frequency gradient and outcome after PV isolation. METHODS: Patients with either paroxysmal or persistent AF were studied. Recordings were made from catheters in the coronary sinus (CS), posterior right atrium (RA), and posterior left atrium (LA) during AF before and after PV isolation. Mean left-to-right dominant frequency gradient was measured before and after segmental PV isolation. Patients were followed for AF recurrence after PV isolation. RESULTS: Twenty-seven patients with paroxysmal (n = 15) or persistent (n = 12) AF were studied. In the paroxysmal group, baseline dominant frequency was greatest in the posterior LA with a significant left-to-right atrial dominant frequency gradient (posterior LA = 6.2 +/- 0.9 Hz, CS = 5.8 +/- 0.8 Hz, posterior RA = 5.4 +/- 0.9 Hz; P <.001). After PV isolation, there was no regional difference in dominant frequency (5.9 +/- 0.7 Hz vs 5.7 +/- 0.6 Hz vs 5.7 +/- 0.7 Hz, respectively; P = NS). In the persistent AF group, there was no overall difference in dominant frequency among sites before or after PV isolation (P = NS); however, patients with long-term freedom from AF after PV isolation had a higher left-to-right dominant frequency gradient compared with patients with recurrent AF (0.4 vs 0.1 Hz; P <.05). CONCLUSION: PV isolation results in a loss in the left-to-right dominant frequency gradient in patients with paroxysmal AF. This finding supports the critical role of PVs in the maintenance of ongoing paroxysmal AF. Patients with persistent AF and a baseline left-to-right dominant frequency gradient have a better success rate with PV isolation alone compared with patients without a dominant frequency gradient.
Authors:
Sorin Lazar; Sanjay Dixit; David J Callans; David Lin; Francis E Marchlinski; Edward P Gerstenfeld
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-04-22
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  3     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-07-31     Completed Date:  2007-01-09     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  889-95     Citation Subset:  IM    
Affiliation:
Department of Medicine, Electrophysiology Division, University of Pennsylvania Health System, Philadelphia, 19104, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Analysis of Variance
Atrial Fibrillation / epidemiology,  physiopathology*,  surgery*
Body Surface Potential Mapping
Cardiac Pacing, Artificial
Catheter Ablation*
Confounding Factors (Epidemiology)
Electrophysiologic Techniques, Cardiac
Female
Follow-Up Studies
Heart Conduction System / physiopathology*,  surgery*
Humans
Male
Middle Aged
Pulmonary Veins / surgery*
Recurrence
Reoperation
Signal Processing, Computer-Assisted
Treatment Outcome
Comments/Corrections
Comment In:
Heart Rhythm. 2006 Aug;3(8):896-7   [PMID:  16876736 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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