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Location and coupling interval of an ectopic excitation determine the initiation of atrial fibrillation from the pulmonary veins
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  • Shunsuke Kawai,
  • Yasushi Mukai,
  • Shujiro Inoue,
  • Daisuke Yakabe,
  • Kazuhiro Nagaoka,
  • Kazuo Sakamoto,
  • Susumu Takase,
  • Akiko Chishaki,
  • Hiroyuki Tsutsui
Shunsuke Kawai
Japanese Red Cross Fukuoka Hospital
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Yasushi Mukai
Japanese Red Cross Fukuoka Hospital
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Shujiro Inoue
Kyushu University Graduate School of Medical Sciences
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Daisuke Yakabe
National Hospital Organisation Kyushu Medical Center
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Kazuhiro Nagaoka
Kyushu University Graduate School of Medical Sciences
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Kazuo Sakamoto
Kyushu University Graduate School of Medical Sciences
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Susumu Takase
Kyushu University Graduate School of Medical Sciences
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Akiko Chishaki
Fukuoka Dental College
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Hiroyuki Tsutsui
Kyushu University Graduate School of Medical Sciences
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Abstract

Background and Objective: Ectopic beats originating from the pulmonary vein (PV) trigger atrial fibrillation (AF). The purpose of this study was to clarify the electrophysiological determinant of AF initiation from the PVs. Methods: Pacing studies were performed with a single extra stimulus mimicking an ectopic beat in the left superior pulmonary veins (LSPVs) in 62 patients undergoing AF ablation. Inducibility of AF, effective refractory period (ERP) and conduction properties within the PVs were analyzed. Results: A single extra stimulus in LSPV induced AF in 20 patients (32% of all patients) at the mean coupling interval (CI) of 172 ms. A CI-dependent anisotropic conduction at the AF onset was visualized in a 3D-mapping. Onset of AF was site-specific with reproducibility in each individual. Mean ERP in LSPV in the AF inducible group was shorter than that in the AF non-inducible group (182 ± 55 ms vs 254 ± 51 ms, P<0.0001). LSPV ERP dispersion was greater in the AF inducible group than in the AF non-inducible group (45 ± 28 ms vs 27 ± 19 ms, P<0.01). Circumferential intra-PV conduction time (IPVCT) exhibited decremental properties in response to shortening of CI, and the prolongation of IPVCT in the AF inducible site was greater than that in the AF non-inducible site (P<0.05) in each individual. Conclusions: Location and coupling interval of an ectopic excitation ultimately determine the initiation of AF from the PVs. ERP dispersion and circumferential conduction delay may lead to anisotropic conduction and reentry within the PVs that initiate AF.

Peer review status:UNDER REVIEW

25 Jun 2021Submitted to Journal of Cardiovascular Electrophysiology
30 Jun 2021Submission Checks Completed
30 Jun 2021Assigned to Editor
05 Jul 2021Reviewer(s) Assigned
23 Jul 2021Review(s) Completed, Editorial Evaluation Pending
26 Jul 2021Editorial Decision: Revise Minor
21 Sep 20211st Revision Received
23 Sep 2021Submission Checks Completed
23 Sep 2021Assigned to Editor
23 Sep 2021Reviewer(s) Assigned