Original-clinicalBehavior of atrial ectopic beats before and after pulmonary vein isolation in patients with atrial fibrillation: A reduction in the number and arrhythmogenicity of ectopic firings
Introduction
It is well known that most episodes of paroxysmal atrial fibrillation (AF) are triggered by atrial premature beats originating from the pulmonary veins (PVs). 1, 2 Although PV isolation using catheter ablation techniques can efficiently suppress the occurrence of AF, 1, 2, 3, 4, 5, 6 atrial premature beats generally do not completely disappear even after successful PV isolation, and the precise nature of residual atrial premature beats has not been elucidated. Therefore, we conducted a study to evaluate the behavior of atrial premature beats through the PV isolation procedure with both a successful and unsuccessful outcome.
Section snippets
Patient population
The study included 120 consecutive patients who underwent PV mapping and ablation for multiple drug-resistant paroxysmal AF and who thereafter could be observed for at least 12 months. The patient population consisted of 92 men and 28 women (mean age 55 ± 8 years). Thirty-four patients had evidence of cardiovascular disease: 24 had hypertension, 8 had coronary artery disease, 3 had dilated cardiomyopathy, and 4 had mitral valve regurgitation. All patients underwent the PV isolation procedure
Results
A total of 476 PVs were ablated, including 120 left superior, 120 right superior, 118 left inferior, and 118 right inferior. Of the total PVs ablated, 99% (475/476) were successfully electrically isolated from the LA. Seventy-eight patients (78/120 [65%]: group 1) became free from AF occurrence after a single procedure. AF recurred in the remaining 42 patients, of whom 30 patients finally became free from AF without antiarrhythmic drugs after multiple ablation sessions (group 2: second, third,
Discussion
Atrial premature beats originating from the PVs play a critical role in AF occurrence.1, 2, 10, 11 Many of these atrial premature beats appear shortly after the preceding normal atrial contractions and conduct to the atrium during its vulnerable period, resulting in induction of AF.1 Although the efficiency of PV isolation in suppressing the occurrence and in the maintenance of AF has already been established,1, 2, 3, 4, 5, 6 no studies evaluating the behavior of atrial premature beats before
Conclusion
PV isolation reduced the number of atrial premature beats in successfully treated AF patients with both rapid and gradual time courses. The residual atrial premature beats appeared to be less arrhythmogenic and to have longer coupling intervals than those at baseline. In patients with AF recurrence, the larger number and shorter coupling intervals of atrial premature beats recovered again, probably due to reconduction of isolated PV. Repeat PV isolation sessions also provided effective
Acknowledgments
We are grateful to Mr. Takuya Seki, Mr. Shigeo Miyagishi, and Mr. Takayuki Kitazawa (Fukuda Denshi Co.) for providing the custom-made software used to analyze the Holter recordings.
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