This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kumagai, K. Articles by Saku, K. Search for Related Content PubMed PubMed Citation Articles by Kumagai, K. Articles by Saku, K.

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

This article has been cited by other articles:

				T. Nitta Invited Commentary Ann. Thorac. Surg., October 1, 2008; 86(4): 1225 - 1226. [Full Text] [PDF]

				T. Rostock, D. Steven, B. Lutomsky, H. Servatius, I. Drewitz, H. Klemm, K. Mullerleile, R. Ventura, T. Meinertz, and S. Willems Atrial fibrillation begets atrial fibrillation in the pulmonary veins on the impact of atrial fibrillation on the electrophysiological properties of the pulmonary veins in humans. J. Am. Coll. Cardiol., June 3, 2008; 51(22): 2153 - 2160. [Abstract] [Full Text] [PDF]

				I. Drewitz, D. Steven, B. Lutomsky, H. Servatius, S. Willems, and T. Rostock Persistent, isolated pulmonary vein re-entry: inducibility, entrainment, and overdrive termination of a sustained tachycardia within an isolated pulmonary vein Europace, March 1, 2008; 10(3): 261 - 264. [Abstract] [Full Text] [PDF]

				A. L. Waldo and G. K. Feld Inter-Relationships of Atrial Fibrillation and Atrial Flutter: Mechanisms and Clinical Implications J. Am. Coll. Cardiol., February 26, 2008; 51(8): 779 - 786. [Abstract] [Full Text] [PDF]

				K. C. Roberts-Thomson, I. H. Stevenson, P. M. Kistler, H. M. Haqqani, J. C. Goldblatt, P. Sanders, and J. M. Kalman Anatomically Determined Functional Conduction Delay in the Posterior Left Atrium: Relationship to Structural Heart Disease J. Am. Coll. Cardiol., February 26, 2008; 51(8): 856 - 862. [Abstract] [Full Text] [PDF]

				E. P. Gerstenfeld Functional Block in the Posterior Left Atrium: Another Piece in the Puzzle of Atrial Fibrillation Initiation J. Am. Coll. Cardiol., February 26, 2008; 51(8): 863 - 864. [Full Text] [PDF]

				D. G. Katritsis and A. J. Camm Catheter ablation of atrial fibrillation: do we know what we are doing? Europace, November 1, 2007; 9(11): 1002 - 1005. [Full Text] [PDF]

				K. A. Hafid, H. C. Xin, W. Xi, Z. Q. Yan, and Y. Bo Difference between electrical remodelling after pulmonary veins and right atrium appendage pacing Europace, July 13, 2007; (2007) eum108v1. [Abstract] [Full Text] [PDF]

				S. Willems, H. Klemm, T. Rostock, B. Brandstrup, R. Ventura, D. Steven, T. Risius, B. Lutomsky, and T. Meinertz Substrate modification combined with pulmonary vein isolation improves outcome of catheter ablation in patients with persistent atrial fibrillation: a prospective randomized comparison Eur. Heart J., December 1, 2006; 27(23): 2871 - 2878. [Abstract] [Full Text] [PDF]

				P. Coutu, D. Chartier, and S. Nattel Comparison of Ca2+-handling properties of canine pulmonary vein and left atrial cardiomyocytes Am J Physiol Heart Circ Physiol, November 1, 2006; 291(5): H2290 - H2300. [Abstract] [Full Text] [PDF]

				Y.-J. Lin, C.-T. Tai, T. Kao, H.-W. Tso, S. Higa, H.-M. Tsao, S.-L. Chang, M.-H. Hsieh, and S.-A. Chen Frequency Analysis in Different Types of Paroxysmal Atrial Fibrillation J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1401 - 1407. [Abstract] [Full Text] [PDF]

				M. Hocini, P. Jais, P. Sanders, Y. Takahashi, M. Rotter, T. Rostock, L.-F. Hsu, F. Sacher, S. Reuter, J. Clementy, et al. Techniques, Evaluation, and Consequences of Linear Block at the Left Atrial Roof in Paroxysmal Atrial Fibrillation: A Prospective Randomized Study Circulation, December 13, 2005; 112(24): 3688 - 3696. [Abstract] [Full Text] [PDF]

				A. Verma, A. Natale, B. J. Padanilam, E. N. Prystowsky, A. Verma, A. Natale, B. J. Padanilam, and E. N. Prystowsky Why Atrial Fibrillation Ablation Should Be Considered First-Line Therapy for Some Patients Circulation, August 23, 2005; 112(8): 1214 - 1222. [Full Text] [PDF]

				S. S. Po, Y. Li, D. Tang, H. Liu, N. Geng, W. M. Jackman, B. Scherlag, R. Lazzara, and E. Patterson Rapid and Stable Re-Entry Within the Pulmonary Vein as a Mechanism Initiating Paroxysmal Atrial Fibrillation J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1871 - 1877. [Abstract] [Full Text] [PDF]