Confined thoracic vein fibrillation: Prevalence and electrophysiological properties

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• 作者：Shinsuke Miyazaki ; MD^a ; ^{mshinsuke@k3.dion.ne.jp" class="auth_mail} ; Shigeki Kusa ; MD^a ; Hiroshi Taniguchi ; MD^a ; Jin Iwasawa ; MD^a ; Akio Kuroi ; MD^a ; Hitoshi Hachiya ; MD^a ; Kenzo Hirao ; MD^b ; Yoshito Iesaka ; MD^a
• 刊名：American Heart Journal
• 出版年：April, 2014
• 年：2014
• 卷：167
• 期：4
• 页码：610-619
• 全文大小：2375 K

文摘

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Introduction

Confined thoracic vein fibrillation (cTVT) is a finding that suggests that thoracic vein acts as a rapid driver to maintain atrial fibrillation (AF). However, little is known about the cTVT.

Methods and Results

Among consecutive 655 patients (age 62 卤 0 years, 492 men, 421 paroxysmal) who underwent circumferential pulmonary vein (PV) antrum isolation for AF, cTVT was identified in 28 (4.3%) patients. The prevalence was significantly higher in patients with paroxysmal AF than in those with nonparoxysmal AF (5.9% vs 1.3%, P = .002). The cTVT was observed in left PVs in 15 (53.6%), right PVs in 11 (39.3%), and superior vena cava in 2 (7.1%) patients. The median cycle length of cTVT was 150 (110-170) ms. The cTVT was recognized when sinus rhythm was restored from AF during vein isolation in 14 patients. Dissociated activity was seen after the termination of cTVT in 23 (82.1%) patients, and cTVT reinitiated spontaneously after the dissociated activity. In 2 patients, AF was not terminated by multiple cardioversions before the isolation, even with a maximal energy delivery. At a median follow-up of 12.0 (7.5-20.5) months, 26 patients (92.9%) were free from AF without antiarrhythmic drugs after a mean of 1.4 卤 0.5 procedures per patient. Notably, recurrent arrhythmia was not observed in any patient (n = 6), wherein cTVT was terminated by additional radiofrequency applications inside an isolated area after the achievement of vein isolation.

Conclusions

Confined thoracic vein fibrillation is not a rare finding in patients with paroxysmal AF, and its elimination results in an excellent clinical outcome.