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Europace 2003 5(1):25-31; doi:10.1053/eupc.2002.0283
© 2003 by European Society of Cardiology
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Effect of atrial overdrive pacing on pulmonary vein focal discharge in patients with atrial fibrillation

T. Arentz1, P. Ott2, J. von Rosenthal1, T. Blum1 and D. Kalusche1

1Herz-Zentrum Bad Krozingen Rhythmologie, Germany; 2Sarver Heart Center, University of Arizona Tucson, AZ, U.S.A.

AIMS: Recently, it has been shown that atrial fibrillation may be caused by spontaneously discharging foci located predominantly in the pulmonary veins. However, the effect of atrial overdrive pacing on these pulmonary vein foci has not been studied.

METHODS AND RESULTS: In 58 patients with drug refractory paroxysmal or persistent atrial fibrillation we performed radiofrequency catheter ablation of arrhythmogenic triggers inside the pulmonary veins and/or an ostial pulmonary vein isolation with conventional mapping and ablation technology. Continuous bigeminal pattern of discharge from one or more arrhythmogenic pulmonary veins was recorded in 14 patients. Atrial overdrive pacing resulted in suppression of pulmonary vein ‘focus’ activity in all patients. The longest mean atrial pacing cycle length resulting in overdrive suppression was 587±114 ms. Independent of pacing rate and duration, bigeminal pulmonary vein focus activity reemerged 2·5±3·7 s after cessation of pacing. Overdrive suppression of the pulmonary vein focus was incomplete in 9 pacing attempts, and resulted in induction of atrial fibrillation from the same vein in 3 of 31 pacing manoeuvres. At 2 years follow-up 79% of these patients were free of atrial fibrillation, 55% without antiarrhythmic drugs, 24% on previously ineffective antiarrhythmic drug therapy.

CONCLUSION: Stable pulmonary vein ‘focus’ activity in patients with atrial fibrillation can be suppressed by atrial overdrive pacing. However, ‘proarrhythmic’ effects of atrial overdrive pacing, such as induction of atrial fibrillation, were also seen.

Key Words: Atrial fibrillation, pulmonary vein foci, transseptal electrophysiological study, catheter ablation, overdrive pacing

Correspondence: Thomas Arentz, M.D., Herz-Zentrum, Rhythmologie, Südring 15, 79188 Bad Krozingen, Germany. Tel.: 49.7633.4020; Fax: 49.7633.402538; E-mail: thomas.arentz{at}herzzentrum.de


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