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CLINICAL RESEARCH: ELECTROPHYSIOLOGY

Electrophysiologic properties of pulmonary veins assessed using a multielectrode basket catheter

^* Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan

Manuscript received October 15, 2003; revised manuscript received January 8, 2004, accepted January 12, 2004.

^* Reprint requests and correspondence: Dr. Koichiro Kumagai, Department of Cardiology, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
kxk{at}fukuoka-u.ac.jp

OBJECTIVES: The purpose of the present study was to evaluate the electrophysiologic properties within the pulmonary vein (PV) and at the PV–left atrial (LA) junction.

BACKGROUND: It has been recognized that atrial fibrillation (AF) can originate from PVs. However, the electrophysiologic properties of the PV have not been well characterized.

METHODS: Thirty-two bipolar electrograms were recorded simultaneously from a basket catheter placed in 81 PVs of 48 patients with paroxysmal AF. The programmed stimulation was performed in the distal PV and PV-LA junction. Activation maps of PVs were analyzed from episodes of spontaneous onset of AF and initiation of induced AF by a single extrastimulus.

RESULTS: The effective refractory period (ERP) of the distal PV was significantly shorter than that of the PV-LA junction (177 ± 43 vs. 222 ± 30 ms, p < 0.0001). The conduction delay from the distal PV to the PV-LA junction was significantly longer than that from the PV-LA junction to distal PV (73 ± 40 vs. 32 ± 17 ms, p < 0.0001). During initiation of AF, a short coupled extrastimulus or rapid, repetitive focal activities originating from the PV formed a PV-LA reciprocating re-entrant circuit involving exit and entrance breakthrough points at the PV-LA junction. Also, an unstable re-entrant circuit within the PV was observed.

CONCLUSIONS: The presence of ERP heterogeneity and anisotropic conduction properties within the PV and at the PV-LA junction may be crucial to promote re-entry formation and thus might play an important role as a substrate for the maintenance of AF.

Abbreviations and Acronyms   AF = atrial fibrillation   CS = coronary sinus   ERP = effective refractory period   LA = left atrium   LAA = left atrial appendage   LSPV = left superior pulmonary vein   PV = pulmonary vein   RSPV = right superior pulmonary vein

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