Journal Article

Effect of atrial overdrive pacing on pulmonary vein focal discharge in patients with atrial fibrillation

T. Arentz, P. Ott, J. von Rosenthal, T. Blum and D. Kalusche

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 5, issue 1, pages 25-31
Published in print January 2003 | ISSN: 1099-5129
Published online January 2003 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1053/eupc.2002.0283
Effect of atrial overdrive pacing on pulmonary vein focal discharge in patients with atrial fibrillation

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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.

Keywords: Atrial fibrillation; pulmonary vein foci; transseptal electrophysiological study; catheter ablation; overdrive pacing

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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