Background
: Pulmonary vein (PV) activity is crucial in some forms of clinical atrial fibrillation (AF), particularly paroxysmal lone AF. The precise importance of PVs in AF associated with structural heart disease is less clear. Some evidence suggests that PVs may be important for AF in experimentally-remodeled atrial substrates, e.g. atrial-tachycardia remodeling (ATR) and congestive heart failure (CHF)-induced structural remodeling, but contradictory findings also exist. This study assessed the role of PVs in canine remodeling-associated AF by evaluating the changes induced by PV-LA disconnection via encircling epicardial ablation.
Methods:
AF was induced before and after complete isolation of all PVs in dogs with:
ATR induced by atrial tachypacing (400 bpm x 1 wk; with AV block and 80 bpm ventricular pacing to control ventricular rate, n=5); and
CHF induced by ventricular tachypacing (VTP, 240 bpm x 2 wks, n=7).
Electrophysiological measurements and AF mapping with 240 unipolar atrial electro-grams in both atria and all PVs were also obtained before and after PV isolation.
Results
ATR reduced atrial ERPs and ERP rate adaptation. The shortest AF cycle length (AFCL) in each ATR dog was recorded from PVs (mean 84±3 ms), but the mean AFCL in each of the PVs (range 97–103 ms) was not different from the mean AFCL at LA sites (98 –103 ms). PV ablation did not affect AF duration in ATR dogs (mean 284±265 pre- vs. 304±225 s post-ablation, P=NS), nor did it significantly alter RA or LA AFCL. In CHF dogs, ERPs and ERP rate adaptation were preserved. The shortest AFCL was recorded in PVs in 2 dogs (108,112 ms) and in the left side of Bachmann’s bundle in 3 (97–117 ms). PV ablation failed to alter AF duration in CHF dogs (mean 778±203 pre- vs. 644±206 s post-ablation), and increased AFCL in RA and LA slightly (10 –15%) but not significantly.
Conclusions
: Uncoupling of the PVs from the LA fails to significantly affect the AF substrate in 2 clinically-relevant animal paradigms of AF-promoting atrial remodeling. These findings suggest that in the presence of a favorable atrial substrate for AF the PVs are not needed for AF maintenance, and are consistent with clinical observations that complete PV isolation may not be essential for effective ablation therapy of all groups of AF patients.
The role of left atrial deformation parameters in the prediction of atrial fibrillation recurrence after cryoballoon ablation therapy
