Long-term clinical implication of the occurrence of dissociated pulmonary vein activities after circumferential left atrial ablation in patients with paroxysmal atrial fibrillation

Abstract

Background: The incidence and clinical implication of dissociated pulmonary vein (PV) electrical activities after circumferential antrum PV ablation for paroxysmal atrial fibrillation (AF) remains unclear. Methods and Results: A total of 196 patients with symptomatic paroxysmal AF who underwent circumferential antrum PV ablation were prospectively studied. Dissociated PV electrical activities were observed in 101 patients (Group 1), but absent in the remaining 95 patients (Group 2). There were no significant differences in the baseline clinical characteristics between them, except that Group 2 had a higher prevalence of hypertension (30 vs. 44%, P=0.04). After 21.8±7.9 months of follow-up, 148 had no recurrence of AF after the initial procedure. AF recurrence rate was significantly higher in Group 2 than in Group 1 (P=0.023). Relapse of PV conduction was the major cause of AF recurrence in both groups (16/16 vs. 19/23, P=0.08), and the overall procedural success rate after the redo ablation procedure was similar in the 2 groups (90 vs. 86%, P=0.44). However, the total number of patients with non-PVfoci was significantly higher in Group 2 than in Group 1 (12/95 vs. 2/101, P<0.01). Conclusions: Dissociated PV electrical activities might identify a subgroup of patients with relatively higher initial procedural success with circumferential PV antrum ablation.