Role of Triggering Pulmonary Veins in the Maintenance of Sustained Paroxysmal Atrial Fibrillation.
Background Triggers from thoracic veins have been implicated not only in the initiation, but also in the perpetuation of paroxysmal atrial fibrillation (PAF). To investigate their role we studied the distribution and stability of dominant frequencies (DFs) during PAF and the response to isolation of...
| Publicado en: | Pacing & Clinical Electrophysiology Vol. 36; no. 7; pp. 845 - 855 |
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| Autores principales: | , , , , , , , , , |
| Formato: | diagnostic images research tables/charts tracings Journal Article |
| Publicado: |
Wiley-Blackwell
Jul2013
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104187066&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104187066 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01478389 4F8 jtl: Pacing & Clinical Electrophysiology issn: 01478389 maglogo: Y pubinfo: dt: Jul2013 vid: 36 iid: 7 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 104187066 88799858 10.1111/pace.12121 NLM23510088 104187066 ppf: 845 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Role of Triggering Pulmonary Veins in the Maintenance of Sustained Paroxysmal Atrial Fibrillation. aug: au: Traykov, Vassil B. Pap, RÓBert Gingl, ZoltÁN Chadaide, Szami Haqqani, Haris M. Klausz, Gergely Gallardo, Rodrigo Forster, TamÁS Callans, David J. SÁGhy, LÁSzlÓ affil: Second Department of Internal Medicine and Cardiology Centre sug: subj: Atrial Fibrillation Pathology Pulmonary Veins Pathology Human Male Female Middle Age Descriptive Statistics Prospective Studies Electrophysiology Fluoroscopy Electrocardiography Data Analysis Software One-Way Analysis of Variance Paired T-Tests Post Hoc Analysis Repeated Measures Isoproterenol Administration and Dosage Adult Aged Funding Source Middle Aged: 45-64 years Adult: 19-44 years Aged: 65+ years Male Female ab: Background Triggers from thoracic veins have been implicated not only in the initiation, but also in the perpetuation of paroxysmal atrial fibrillation (PAF). To investigate their role we studied the distribution and stability of dominant frequencies (DFs) during PAF and the response to isolation of the triggering pulmonary vein (PV). Methods and Results Triggering structures inducing PAF were identified during isoproterenol challenge in 26 patients (15 males, 55 ± 8.5 years). During sustained PAF, sequential recordings were made with a decapolar circular mapping catheter from each PV and the left atrial posterior wall (LAPW), together with coronary sinus (CS) and right atrium (RA) recordings. DF was determined using fast Fourier transformation. Recordings were repeated after ≥15 minutes of PAF. Radiofrequency ablation was directed first at the triggering PVs. PAF initiated from the PVs in 24 patients and from RA in two. There was a significant frequency gradient from the triggering structure to the PVs, CS, LAPW, and RA (P < 0.0001). During the second recording, DF decreased at all sites (P < 0.02), but the frequency gradient remained unchanged. Despite isolation of the triggering PV, PAF continued in 53% of patients, although DF measured in the CS was lower. AF termination occurred with contralateral PV isolation in half of the remaining patients and further AF slowing was noted in the rest. Conclusions Triggering structures harbor the fastest activity during sustained PAF pointing to their leading role in arrhythmia perpetuation. However, nontriggering PVs also seem to contribute to PAF maintenance. pubtype: Academic Journal doctype: diagnostic images research tables/charts tracings Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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