| Introduction Dissociated pulmonary vein rhythm (PVD) as the electrophysiological endpoint of PV isolation occurred in 12～42%of the isolated pulmonary veins (PVs). Acute PV reconnection either induced by adenosine triphosphate (ATP) or observed after 30min post-isolation was common in presumably isolated PVs. The aim of the present study was to evaluate the relationship between PVD and acute PV reconnection.Methods A cohort of 85 consecutive patients (52 males; mean age 59±11 years) were referred for catheter ablation of drug-refractory paroxysmal atrial fibrillation. Following PV isolation, the presence and cycle length (CL) of PVD in ipsilateral PVs were analyzed without and with isoproterenol infusion. Afterwards, acute PV reconnection was assessed by ATP infusion and reassessed after 30min observation time. Re-isolation was performed in PVs with acute PV reconnection (Group 1); no further ablation was applied in PVs without acute PV reconnection (Group 2).PVD was reassessed for 5 minutes after re-isolation in Group 1.Results PVD was observed in 68% of the patients (58/85) and 34.7% of the PVs (112/323). PVD was seen most often in the left superior PV (54%; 46/85). A total of 79 (24.5%) PVs were reconnected acutely. There were more PVs with PVD in Group 1 (n=79) than Group 2 (n=244) (50.6%vs.29.5%, P=0.0006). The CL of PVD after PV isolation was 1932.8±1309.4ms, and was shortened to 991.9±431.7ms after isoproterenol infusion (P<0.01). The cycle length of PVD without and with isoproterenol in Group 1 were not significantly different from Group 2 (1737.6±950.8 vs.1899.4±1200.5, P>0.05; 951.8±311.5 vs.1161.4±519.6,P>0.05, respectively). After re-isolation in Group 1,85%(34/40) PVD disappeared.Conclusion PVD is common, occurring in 34.7%of PVs. The presence of PVD is significantly predictive of acute PV reconnection. It may not be reliable to consider PVD as the electrophysiological endpoint of PV isolation. |
