ABSTRACT
OBJECTIVE: To evaluate the progression of electrophysiological phenomena in atrial fibrillation (AF) and elucidate the association between the left atrial conduction velocity (LACV) and AF recurrence after pulmonary vein isolation. METHODS: A total of 188 AF patients (121 paroxysmal AF and 67 persistent AF) who underwent PVI for the first time were enrolled in this prospective study. The left atrium was mapped using a 20-pole electrode catheter combined with the CARTO3 system. The conduction distances and conduction times of the left atrium from the Bachmann bundle area to the mitral isthmus were calculated. Anterior, posterior, and septal LACV were calculated as conduction distance divided by conduction time. RESULTS: The anterior, posterior, and septal LACVs in the AF recurrence group were slower than those in the nonrecurrence group (anterior: 0.807 [0.766, 0.848] and 1.048 [1.000, 1.093] m/s, p < .05; posterior: 1.037 [0.991, 1.084] vs. 1.315 [1.249, 1.380] m/s, p < .05; septal: 0.904 [0.862, 0.946] vs. 1.163 [1.107, 1.219] m/s, p < .05). The best cut-off value of anterior LACV for predicting AF recurrence was 0.887 m/s (sensitivity 73.9% and specificity 76.5%). Multivariate analysis showed slow anterior LACV <0.887 m/s was an independent predictor of AF recurrence with an adjusted odds ratio of 1.42 (1.04, 1.94). CONCLUSIONS: Slowing conduction velocity is a predictor of AF recurrence after pulmonary vein isolation.