Clinical Investigation Of Pulmonary Vein Potential In Subjects With And Without Atrial Fibrillation

Objective: To study the characteristics of atrial fibrillation by analyzing the properties of pulmonary vein(PV) and pulmonary vein potential(PVP) in subjects with paroxysmal atrial fibrillation(PAF) and without atrial fibrillation(AF). Materials and Methods: Two groups were selected to study , Non-AF group: twenty-one patients(male 13, female 8, mean age 42.7±12.3 years) undergoing transeptal radiofrequency catheter ablation(RFCA) for left atrial-ventricular reentrant tachycardia, who were free from AF and other cardiac disease; PAF group: twenty-five patients (male 5, female 20, mean age 51.8±13 .0 years) with drug-refractory AF undergoing PV ablation for paroxysmal atrial fibrillation, of whom two patients with hypertension, six patients with enlarge left atrium, All the patients had been prepared similarly to receive RFCA procedure. A 6F quadripolar catheter was placed in the coronary sinus(CS), another bipolar one was placed in the right ventricle. After transeptal puncture successfully, heparin was given intravenously. Selective pulmonary vein venography through 8F-Swartz catheter allowed placement of an appropriate-size decapolar-performed circular catheter(Lasso) in the PVs. Bipolar electrogrames of PV were recorded on a multichannel polygraphy with surface ECG , Cs atrial electrogrames. Otherwise, The correlation and compared data of the diameter of left atrium, PV ostia and PVP between two groups were analyzed.Result : There were 120 PVs exhibited by pulmonary venography, five patients had right middle PV, two patients had left common ostia. The patients with PAF were older that those with NAF, while left atriums of PAF were larger than ones of NAF. No significant difference was observed in each PV diameter, even between PAF and NAF. In every patients, PVP had been recorded in two or more PVs, which was no significant difference between two groups. PVPs in NAF were mono-morphogeny, regular electric-activity, order of PVP and A(far-field atrial potential)was variable, and most PVPs were slower than atrial potential in CS . PVPs in PAF were multiplex. On sinus rhythm, they were similar to those of NAF. when AF occurred on surface ECG, proximal, rapid and regular or irregular PVP appeared, PVP jumped in front of A , whose frequency increased correspondently. And initiation of PVP was changed, maybe multifocal. Sometimes, slow PV activity dissociated from AF. Conclusion:1. During the early period of PAF, there is no significantcorrelation between AF and PV ostia diameter, and so is leftatrial diameter, age.2. PVP can be recorded in every patients, the elimination of the potentials is the landmark of PV isolated successfully, but it does not mean the cure of AF.3. Some intracardiac electrophysiology of PVP with PAF: when AF occurs, PVP comes before atrial potential and obviously faster than sinus rhythm with regular or irregular activity, whose frequency is not slower than atrial potential in CS with or without 1:1capture, and the route of activity also changes with multiform or multifocal PVP.4. Under physiological condition, PVP is ordinal and regular activity. Nevertheless, the speciality of PV that includes anisotropy structure and shorter refractory period contributing to dispersion refractory periods and conduction decrement or block, which could induce fast irregular activity by reentrant, then AF can be triggered or driven, or take part in the reentrant between PV/PV ostia and left atrium.