© 2003 by European Society of Cardiology
Effect of atrial overdrive pacing on pulmonary vein focal discharge in patients with atrial fibrillation
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
[1] Prystowsky EN, Benson DW, Fuster V, et al. Management of patients with atrial fibrillation: A statement for healthcare professionals from the subcommittee on electrocardiography and electrophysiology. American Heart Association. Circulation 1996; 93: 1262–1277.[Medline]
[2] Benjamin EJ, Wolf PA, d'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: The Framingham Heart Study. Circulation 1998; 98: 946–952.
[3] Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins. N Engl J Med 1998; 39: 659–666.
[4] Haïssaguerre M, Jaïs P, Shah D, et al. Electrophysiological endpoint for catheter ablation of atrial fibrillation initiated from multiple pulmonary vein foci. Circulation 2000; 101: 1409–1417.
[5] Chen SA, Hsieh MH, Tai CT, et al. Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins. Electrophysiological characteristics, pharmacological responses, and effect of radiofrequency ablation. Circulation 1999; 100: 879–1886.
[6] Nathan H and Eliakim M. The junction between the left atrium and the pulmonary veins. An anatomic study of human hearts. Circulation 1966; 34: 412–422.
[7] Saito T, Waki K, Becker AE. Left atrial myocardial extension into pulmonary veins in humans: anatomic observations relevant for atrial arrhythmias. J Cardiovasc Electrophysiol 2000; 11: 888–894.[Web of Science][Medline]
[8] Jaïs P, Peng JT, Shah DC, et al. Left ventricular dysfunction in patients with so-called lone atrial fibrillation. J Cardiovasc Electrophysiol 2000; 11: 623–625.[Web of Science][Medline]
[9] Blom NA, Gittenberger-de Groot AC, DeGruiter MC, Poelman RE, Mentink MMT, Ottenkamp J. Development of the cardiac conduction tissue in human embryos using HNK-1 antigen expression: possible relevance for understanding of abnormal atrial automaticity. Circulation 1999; 99: 800–806.
[10] Spach MS, Dolber PC, Heidlage F. Influence of the passive anisotropic properties on directional differences in propagation following modification of the sodium conductance in human atrial muscle: A model of reentry based on anisotropic discontinuous propagation. Circ Res 1988; 62: 811–832.
[11] Chauvin M, Marcellin L, Shah DC, Douchet MP, Jaïs P, Haïssaguerre M. Disorganized myocardial muscle in pulmonary veins and their ostia in man. Pacing Clin Electrophysiol 2001; 24: 586 (Abstract).
[12] Jaïs P, Deisenhoffer I, Macle L, et al. Marked heterogeneity of conduction and refractoriness in human pulmonary veins. Pacing Clin Electrophysiol 2001; 24: 586 (Abstract).
[13] Murgatroyd FD, Nitsche R, Slade AK, et al. A new pacing algorithm for the overdrive suppression of atrial fibrillation. Chorus Multicentre Study Group. Pacing Clin Electrophysiol 1994; 17: 1966–1973.[CrossRef][Medline]
[14] Ricci R, Puglisi A, Peraldo C, et al. Consistent atrial pacing: Can a new algorithm suppress recurrent paroxysmal atrial fibrillation? Pacing Clin Electrophysiol 1997; 20: 1227 (Abstract).
[15] Delfaut P, Prakash A, Giorgberidze I, et al. Continuous overdrive pacing prevents recurrent atrial fibrillation during single and dual site right atrial pacing. Pacing Clin Electrophysiol 1997; 20: 1074 (Abstract).
[16] Sakzena S, Prakash A, Hill M, et al. Prevention of recurrent atrial fibrillation with chronic dual site right atrial pacing. J Am Coll Cardiol 1996; 28: 687–694.[Abstract]
[17] Papageorgiou P, Anselme F, Kirchhof CJ, et al. Coronary sinus pacing prevents induction of atrial fibrillation. Circulation 1997; 96: 1893–1898.
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