The Association between Dissociated Pulmonary Vein Activity and Types of Recurrence in Paroxysmal Atrial Fibrillation Patients

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Background: The dissociated activities (DAs) indicates arrhythmogenicity of the isolated PV after the pulmonary vein isolation (PVI) for atrial fibrillation (AF). We investigated its impact on AF recurrence after the PVI. Methods: The subjects were 84 paroxysmal AF patients (age: 55±9, 71 males) who had recurrence after PVI and underwent the repeat procedure. All patients were divided into two groups regarding to the presence/absence of DAs during the first procedure (group A: DAs in ≥1PV, group B: no DA). Results: Group A and B consisted of 62 and 22 patients, respectively. In the repeat session, the number of reconnected PVs was similar between the two groups (203/246 (83%) PVs vs. 69/87 (79%) PVs, P=0.61). The mean age was significantly higher (60±8 vs. 54±11 years, P<0.01) and non-PV ectopic foci were more frequently observed (68% (15/22) vs. 29% (18/62), P=0.003) in group B compared to group A. Additionally, 73% (11/15) of patients of group B demonstrated ectopic beats from superior vena cava (SVC). Conclusions: Absence of DAs after PVI might indicate the presence of concealed non-PV foci initiating AF in paroxysmal AF patients. Supplemental SVC isolation should be considered in cases without DAs in PVs during the first procedure.