Key result
Concealed pulmonary vein bigeminy is linked to ~5-fold higher provoked focal firing before ablation.
Why the study?
The association between concealed pulmonary vein bigeminy during sinus rhythm and pulmonary vein firing in patients with paroxysmal atrial fibrillation was unclear.
Does the presence of concealed pulmonary vein bigeminy during sinus rhythm predict higher PV firing and AF recurrence in patients with paroxysmal AF undergoing PV isolation?
Cohort (n=198)
Does the presence of concealed pulmonary vein bigeminy during sinus rhythm predict higher PV firing and AF recurrence in patients with paroxysmal AF undergoing PV isolation?
Concealed pulmonary vein bigeminy during sinus rhythm identifies PVs with higher focal firing and patients at increased risk of AF recurrence following ablation.
Answers are grounded in this paper and cite their sources.
Concealed PV bigeminy may identify higher-risk veins during ablation; leaves open whether targeting it improves long-term AF outcomes.
Introduction. A concealed pulmonary vein (PV) bigeminy (cPVB) may be found in some patients with atrial fibrillation (AF) during sinus rhythm (SR). The aim of this study was to investigate whether the presence of cPVB during SR is associated with a higher PV firing. Methods and Results. Seven hundred seventy-six PVs (excluding 5 right middle PVs and 8 left common trunks) were mapped in 198 patients with paroxysmal AF (PAF) who underwent circumferential PV isolation. cPVB with a mean coupling interval of 136 ± 16 ms during SR was observed prior to ablation in 22 (11%) patients. Focal firing was provoked prior to ablation in 144 (19%) PVs. The incidence of focal firing was greater in PVs exhibiting cPVB compared with PVs without cPVB (89% vs. 16%; P<0.001 ). Also, the number of radiofrequency applications required for isolation was greater in ipsilateral PVs, exhibiting cPVB compared with ipsilateral PVs without cPVB (21.6 ± 6.8 vs. 18.2 ± 5.6; P=0.024 ). During a follow-up of 32 ± 20 months, the single ablation success rate was 82%. Compared with patients without cPVB, patients with cPVB were associated with higher recurrence rate of AF (27% vs. 17%; p=0.032 ). Conclusion. cPVB during SR was observed prior to index ablation in 11% of PAF patients. Such a potential itself may be a PV firing in a concealed manner, which does not reactivate LA. The PV exhibiting cPVB required a greater number of radiofrequency applications for isolation. Compared to patients without cPVB, the recurrence rate of AF in patients with cPVB was greater.
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Hu et al. (2018) conducted a cohort in Paroxysmal Atrial Fibrillation (n=198). Concealed pulmonary vein bigeminy (cPVB) during sinus rhythm vs. Absence of cPVB was evaluated on Focal firing provoked prior to ablation (p=<0.001). Concealed pulmonary vein bigeminy during sinus rhythm was associated with a higher incidence of focal firing (89% vs. 16%; P<0.001) and a higher AF recurrence rate (27% vs. 17%; P=0.032).
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