Clinical Implication Of The Different Rate Spontaneous Dissociated Potentials In Pulmonary Vein After Circumferential Pulmonary Vein Isolation In Patients With Paroxysmal Atrial Fibrillation

Objective: The goal of this study was to assess the distribution of different rate spontaneouse dissociated potentials(SDPs)in pulmonary vein(PV)after circumferential pulmonary vein isolation(CPVI).Furthermore,we investigate the relationship between different rate SDPs and chronic PV reconnection after CPVI in patients with paroxysmal atrial fibrillation(PAF).Methods: A total of 97 PAF patients(age,58 ± 11 years)undergoing CPVI were enrolled.After CPVI was done,intravenous adenosine(20 mg)was administered and the presence of SDPs was recorded.Patients were divided into fast SDP group(SDP cycle length < 2000 ms),slow SDP group(SDP cycle length ? 2000 ms)and silent SDP group(no SDPs).AF recurrence was assessed with 24-hour Holter at 3,6 and 12 months.The reconnection of each PV was detected in recurrent patients who underwent redo procedures.Results: Acute CPVI was accomplished in all(100%)patients.After CPVI,99 PVs were recorded fast SDPs(25.5%),76 PVs were recorded slow SDPs(19.6%)and 213 PVs were silent(54.9%).Fast SDPs were significantly more common in left superior pulmonary vein(LSPV)and right superior pulmonary vein(LSPV)than that in right inferior pulmonary vein(RIPV)and left inferior pulmonary vein(LIPV)(30 vs.39 vs.16 vs.14,P < 0.05).At a mean follow-up of 13.7±7.4 months,18 patients(18.6%)were recurrent with AF.Of the 48 PVs in the 12 recurrent patients who underwent redo procedure,the reconnection of PVs in the fast SDP group was higher than that in the slow SDP group and silent group(76.9% vs.33.3% vs.35%,P < 0.05).Conclusion: Fast SDPs are more common in RSPV and LSPV than that in RIPV and LIPV after CPVI in patients with PAF.Fast SDP may be a predictor of chronic reconnection of PV after CPVI in PAF patients.