Acute effect of circumferential pulmonary vein isolation on left atrial substrate

Abstract

Introduction: The left atrial (LA) substrate plays an important role in the maintenance of atrial fibrillation (AF). However, little is known about the acute effect of circumferential pulmonary vein isolation (CPVI). This study was to investigate the acute change of LA activation, voltage and P wave in surface electrocardiogram (ECG) after CPVI.

Methods and results: Electroanatomic mapping (NavX) was performed in 50 patients with AF (mean age = 54 +/- 10 years, 36 males) who underwent only CPVI. The mean peak-to-peak bipolar voltage and total activation time of LA were obtained during sinus rhythm before and immediately after CPVI. The average duration and amplitude of P waves in 12-lead ECG were also analyzed before and after CPVI. Change in the earliest LA breakthrough sites could cause decreased LA total activation time. Downward shift in the breakthrough site was inversely proportional to the proximity of the breakthrough site to the radiofrequency lesions. A shortening of P-wave duration and decrease in voltage after CPVI were observed after CPVI. Patients with recurrent AF had less voltage reduction in the atrial wall 1 cm from the circumferential PV lesions compared with those without recurrent AF (60.1 +/- 11.7% vs 74.1 +/- 6.6%, P = 0.002). Reduction of voltage < or = 64.4% in this area after CPVI is related with recurrent AF.

Conclusion: CPVI could result in acute change of LA substrate, involving LA activation and voltage. Less reduction of voltage in the atrial wall adjacent to the circumferential PV lesions after CPVI may be associated to the recurrence of AF.