Key result
AF linked to ~27% higher incidence of conduction delay and block at the pulmonary vein.
Why the study?
There were no prior reports quantifying the extensiveness of conduction delay and block at the pulmonary vein area and their clinical relevance in atrial fibrillation.
Does the extensiveness of conduction delay and block at the pulmonary vein area differ between patients with and without atrial fibrillation?
Cross-Sectional (n=268)
Does the extensiveness of conduction delay and block at the pulmonary vein area differ between patients with and without atrial fibrillation?
Patients with atrial fibrillation exhibit more extensive and continuous lines of conduction delay and block at the pulmonary vein area compared to those without AF, though these mapping parameters do not distinguish between paroxysmal and persistent AF types.
AF-associated PV conduction abnormalities support mechanistic hypotheses; leaves open clinical relevance pending prospective outcome studies.
BACKGROUND: Areas of conduction delay (CD) or conduction block (CB) are associated with higher recurrence rates after ablation therapy for atrial fibrillation (AF). OBJECTIVE: Thus far, there are no reports on the quantification of the extensiveness of CD and CB at the pulmonary vein area (PVA) and their clinical relevance. METHODS: Intraoperative high-density epicardial mapping of the PVA (interelectrode distance 2 mm) was performed during sinus rhythm in 268 patients (mean ± SD [minimum-maximum] 67 ± 11 [21-84] years) with and without preoperative AF. For each patient, extensiveness of CD (conduction velocity 17-29 cm/s) and CB (conduction velocity <17 cm/s) was assessed and related to the presence and type of AF. RESULTS: CD and CB occurred in, respectively, 242 (90%) and 183 (68%) patients. Patients with AF showed a higher incidence of continuous conduction delay and block (CDCB) lines (AF: n = 37 [76%]; no AF: n = 132 [60%]; P = .046), a 2-fold number of lines per patient (CD: 7 [0-30] vs 4 [0-22], P < .001; CB: 3 [0-11] vs 1 [0-12], P = .003; CDCB: 2 [0-6] vs 1 [0-8], P = .004), and a higher incidence of CD or CB lines ≥6 mm and CDCB lines ≥16 mm (P = .011, P = .025, and P = .027). The extensiveness of CD, CB, and CDCB could not distinguish between the different AF types. CONCLUSION: Patients with AF more often present with continuous lines of adjacent areas of CD and CB, whereas in patients without AF, lines of CD and CB are shorter and more often separated by areas with normal intra-atrial conduction. However, a considerable overlap in the amount of conduction abnormalities at the PVA was observed between patients with a history of paroxysmal and persistent AF.
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Mouws et al. (2018) conducted a cross-sectional in Atrial fibrillation (n=268). Preoperative atrial fibrillation vs. No preoperative atrial fibrillation was evaluated on Incidence of continuous conduction delay and block (CDCB) lines (p=.046). Patients with atrial fibrillation had a higher incidence of continuous conduction delay and block lines at the pulmonary vein area compared to those without AF (76% vs 60%; P=0.046).
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