Relationship between arrhythmogenic pulmonary veins and the surrounding atrial substrate in patients with paroxysmal atrial fibrillation

Kazuyoshi Suenari, Yenn Jiang Lin, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Ta Chuan Tuan, Shih Yu Huang, Ching Tai Tai, Yukiko Nakano, Yasuki Kihara, Hsuan Ming Tsao, Tsu Juey Wu, Shih Ann Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Arrhythmogenic PVs and the Fibrillatory Activities. Introduction: The relationship between pulmonary veins (PVs) with atrial fibrillation (AF) initiating triggers and their surrounding atrial substrate has not been elucidated. We aimed to clarify the atrial substrate properties around the PVs. Methods and Results: Twenty-three paroxysmal AF patients were studied with the identification of PV initiating triggers. High-density mapping of the dominant frequency (DF, 1200 Hz) and the mean degree of the complex fractionated electrograms (CFE mean interval over 6 seconds) was evaluated in 2 zones (zone 1: < 5 mm, zone 2: 5-15 mm from the PVs) and the left atrial (LA) using a NavX system prior to the PV isolation. High-DFs (>8 Hz) and continuous CFEs (<50 ms) were identified in 1.5 ± 0.9 and 2.3 ± 1.1 regions per patient, respectively. Most of the high-DF regions (86%) and continuous CFE regions (77%) were located within 15 mm of the PV ostia. Of those, 75% of the high-DF regions and 54% of the continuous CFE regions were related to arrhythmogenic PVs. There was a significant DF gradient from arrhythmogenic PV zone 1 to zone 2, while the mean CFE exhibited a significant gradient between arrhythmogenic PV zone 2 and the rest of the LA. Additionally, 69% of the procedural AF termination sites were at arrhythmogenic PV zone 2. Conclusion: Evaluation of the atrial substrate properties may be useful for locating arrhythmogenic PVs during AF and defining the extent of the circumferential PV isolation.

Original languageEnglish
Pages (from-to)405-410
Number of pages6
JournalJournal of cardiovascular electrophysiology
Issue number4
StatePublished - Apr 2011


  • atrial fibrillation
  • atrial substrate
  • catheter ablation
  • complex fractionated atrial electrograms
  • dominant frequency analysis


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