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

T. Arentz, Peter - Ott, J. von Rosenthal, T. Blum, D. Kalusche

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)25-31
Number of pages7
JournalEuropace
Volume5
Issue number1
DOIs
StatePublished - Jan 2003

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Pulmonary Veins
Patient Discharge
Atrial Fibrillation
Anti-Arrhythmia Agents
Catheter Ablation
Veins
Technology
Drug Therapy

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Overdrive pacing
  • Pulmunary vein foci
  • Transseptal electrophysiological study

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of atrial overdrive pacing on pulmonary vein focal discharge in patients with atrial fibrillation. / Arentz, T.; Ott, Peter -; von Rosenthal, J.; Blum, T.; Kalusche, D.

In: Europace, Vol. 5, No. 1, 01.2003, p. 25-31.

Research output: Contribution to journalArticle

Arentz, T. ; Ott, Peter - ; von Rosenthal, J. ; Blum, T. ; Kalusche, D. / Effect of atrial overdrive pacing on pulmonary vein focal discharge in patients with atrial fibrillation. In: Europace. 2003 ; Vol. 5, No. 1. pp. 25-31.
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AB - 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.

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