Dissociated pulmonary vein rhythm may predict the acute pulmonary vein reconnection post-isolation in patients with paroxysmal atrial fibrillation.

ABSTRACT

AIMS: Dissociated pulmonary vein rhythm (PVD) has been taken as a signal of PV isolation, but has been questioned recently; we assessed the relationship between PVD and acute PV reconnection after PV isolation in this study. METHODS AND RESULTS: Eighty-five consecutive patients (52 males; mean age 59±11 years) were referred for catheter ablation of drug-refractory paroxysmal AF. Following PV isolation, the presence and cycle length of PVD were recorded. Pulmonary veins were classified into veins with PVD (Group 1) and veins without PVD (Group 2). Adenosine triphosphate (ATP) was then injected during isoproterenol infusion to reveal dormant conduction gap(s), and PVs were further remapped at 30 min post-isolation. Totally, PVD was observed in 68% (58 of 85) of patients and 34.7% (112 of 323) of PVs. Seventy-nine (24.5%) PVs were found acutely reconnected, including 48 veins revealed by ATP induction [ATP(+)PV] and 64 veins by reassessment after 30 min post-isolation [Time(+)PV]. Time(+)PVs were observed more frequently in Group 1 than those in Group 2 (31.3 vs. 13.7%, P<0.01), but no significant difference was found in the occurrence of ATP(+)PVs between Group 1 and Group 2 (17.9 vs. 13.3%, P=0.27). The sequences of the PVD and the acutely reconnected PV potential were similar in 87.5% of veins. After PV re-isolation, 70% (28 of 40) of previously documented PVD disappeared. CONCLUSION: The occurrence of PVD after PV isolation was closely related to the acute PV reconnection after 30 min post-isolation.