Key result
The presence of dissociated pulmonary vein activity after pulmonary vein isolation was not predictive of arrhythmia recurrence during follow-up (23% vs 32%; P=0.23).
Why the study?
Does the presence of dissociated pulmonary vein activity after pulmonary vein isolation predict arrhythmia recurrence in patients with paroxysmal atrial fibrillation?
Observational (n=243)
Does the presence of dissociated pulmonary vein activity after pulmonary vein isolation predict arrhythmia recurrence in patients with paroxysmal atrial fibrillation?
Dissociated pulmonary vein activity after pulmonary vein isolation for paroxysmal atrial fibrillation is not an independent predictor of long-term arrhythmia recurrence.
Does not support targeting dissociated activity; leaves open its prognostic role in prospective AF ablation cohorts.
BACKGROUND: The role of dissociated pulmonary vein (DPV) activity after pulmonary vein isolation (PVI) is still poorly defined. We evaluated electrophysiological features and clinical impact on long-term outcome of DPV activity. METHODS: A total of 243 patients (mean age 63 ± 11 years; 63% males) undergoing PVI for paroxysmal atrial fibrillation (AF) were included. DPV activity was defined as a residual low frequency irregular PV rhythm. Patients were divided into Group 1 (presence of DPV activity; n = 65) or Group 2 (absence of DPV activity; n = 178). RESULTS: Of 936 isolated PVs, 112 PVs (12%) showed DPV activity. DPV activity was observed more frequently in PVs identified as AF triggers (P = 0.026). During follow-up (mean 12 ± 7 months), 15 of 65 patients of Group 1 (23%) and 57 of 178 patients of Group 2 (32%) had an arrhythmia recurrence (P = 0.23). At linear regression analysis, no independent predictor for clinical recurrence was identified. During the repeat ablation, 62 of 72 patients (86%) showed a recovered PV conduction without difference between the 2 groups. Clinically, all patients of Group 1 with PV reconnection (n = 13/15) had a recurrence of paroxysmal AF. In Group 2, 5 of 52 patients with reconnected PV developed non-PV related arrhythmias. CONCLUSION: DPV activity occurred in 12% of PVs after PVI and was observed more frequently in PVs identified as AF triggers. DPV activity was not predictive for AF recurrence during follow-up. PV-left atrium reconnection involving PVs with DPV activity leads to AF.
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Buiatti et al. (2014) conducted an observational in Paroxysmal atrial fibrillation (n=243). Presence of dissociated pulmonary vein (DPV) activity vs. Absence of DPV activity was evaluated on Arrhythmia recurrence (p=0.23). The presence of dissociated pulmonary vein activity after pulmonary vein isolation was not predictive of arrhythmia recurrence during follow-up (23% vs 32%; P=0.23).
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