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Shortening of Fibrillatory Cycle Length in the Pulmonary Vein During Vagal Excitation

Hôpital Cardiologique du Haut-Lévêque–Université Victor Segalen Bordeaux 2, Bordeaux, France.

View larger version (16K): [in a new window]   Figure 1 An overall change in cycle length in the coronary sinus (CSCL) and pulmonary vein (PVCL). *p < 0.0001, CSCL during vagal excitation versus before ablation, before vagal excitation, and after vagal excitation. p = 0.002, PVCL during vagal excitation versus before ablation. p < 0.0001, PVCL during vagal excitation versus before vagal excitation. p < 0.05, PVCL before vagal excitation versus after vagal excitation, p = 0.0001, PVCL during vagal excitation versus during vagal excitation.

View larger version (16K): [in a new window]   Figure 2 Cycle length during vagal excitation in the pulmonary vein (PVCL), pulmonary vein ostium (PVos CL), and coronary sinus (CSCL).

View larger version (46K): [in a new window]   Figure 3 (A) Electrograms during vagal excitation produced by radiofrequency energy delivery for pulmonary vein (PV) isolation in a patient with paroxysmal atrial fibrillation. The last QRS is followed by a sudden decrease in cycle length in the pulmonary vein. Blue and red arrows highlight the atrial activity. (B) Cycle length in the coronary sinus (CS) and PV during the same episode displayed in (A). Mean cycle length in the PV before atrioventricular (AV) block was 151 ms, and decreased to 85 ms during AV block. Mean cycle length in the CS does not change significantly in this episode (150 ms).

View larger version (38K): [in a new window]   Figure 4 (A) Electrograms during vagal excitation in a patient with chronic atrial fibrillation (AF). Blue and red arrows highlight the atrial activity. (B) Cycle length in the coronary sinus (CS) and pulmonary vein (PV) during the same episode displayed in (A). Mean cycle length in the PV decreased from 156 ms to 144 ms during atrioventricular block. Note that changes in cycle length are smaller than in a patient with paroxysmal AF (Fig. 3).

View larger version (15K): [in a new window]   Figure 5 A change in cycle length in the CS (CSCL, A) and PV (PVCL, B) in patients with paroxysmal and chronic atrial fibrillation.

View larger version (21K): [in a new window]   Figure 6 The hypothesized fibrillatory process during vagal excitation and the effect of pulmonary vein (PV) isolation on this process. (A) During vagal excitation, PVs act as driving sources. Acceleration of cycle length in the PVs causes acceleration of cycle length in the coronary sinus (CSCL), thus favoring maintenance of atrial fibrillation. (B) After PV isolation, acceleration of atrial cycle length may be attenuated by elimination of driving sources.