Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation

Shih Ann Chen, Ming Hsiung Hsieh, Ching Tai Tai, Chin Feng Tsai, V. S. Prakash, Wen Chung Yu, Tsui Lieh Hsu, Yu An Ding, Mau Song Chang

Research output: Contribution to journalArticle

1262 Citations (Scopus)

Abstract

Background - Atrial fibrillation (AF) can be initiated by ectopic beats originating from the atrial or great venous tissues. This study investigated the anatomic characteristics and electrophysiological properties of pulmonary veins (PVs), as well as the possible mechanisms and response to drugs of ectopic foci, and assessed the effects of radiofrequency (RF) ablation on AF initiated by ectopic beats originating from PVs. Methods and Results - Seventy-nine patients with frequent episodes of paroxysmal AF and 10 control patients were included. Distal PVs showed the shortest effective refractory periods (ERPs), and right superior PVs showed a higher incidence of intra-PV conduction block than left superior PVs. Superior and left PVs had longer myocardial sleeves than inferior and right PVs, respectively. These electrophysiological characteristics were similar between AF and control patients. Propranolol, verapamil, and procainamide suppressed ectopic beats that originated from the PVs. Of 116 ectopic foci that initiated AF, 103 (88.8%) originated from PVs. A mean of 7±3 RF applications completely eliminated 110 ectopic foci (94.8%). During the 6±2-month follow-up period, 68 patients (86.1%) were free of AF without any antiarrhythmic drugs. Follow- up transesophageal echocardiogram showed 42.4% of ablated PVs had focal stenosis. One patient had mild exertional dyspnea after ablation, but it resolved 3 months later; 1 patient had onset of mild exertional dyspnea 5 months after ablation. Conclusions - Electrophysiological characteristics of PVs are different from those in the atria. Ectopic beats from PVs can initiate AF, and β-adrenergic receptor blocker, calcium channel blockers, and sodium channel blockers can suppress these ectopic beats. Careful mapping and elimination of these ectopic foci can cure paroxysmal AF.

Original languageEnglish
Pages (from-to)1879-1886
Number of pages8
JournalCirculation
Volume100
Issue number18
Publication statusPublished - Nov 2 1999
Externally publishedYes

Fingerprint

Atrial Premature Complexes
Pulmonary Veins
Atrial Fibrillation
Pharmacology
Dyspnea
Sodium Channel Blockers
Procainamide
Adrenergic Antagonists
Anti-Arrhythmia Agents
Calcium Channel Blockers
Verapamil
Propranolol
Adrenergic Receptors

Keywords

  • Ablation
  • Electrophysiology
  • Fibrillation
  • Veins

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins : Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. / Chen, Shih Ann; Hsieh, Ming Hsiung; Tai, Ching Tai; Tsai, Chin Feng; Prakash, V. S.; Yu, Wen Chung; Hsu, Tsui Lieh; Ding, Yu An; Chang, Mau Song.

In: Circulation, Vol. 100, No. 18, 02.11.1999, p. 1879-1886.

Research output: Contribution to journalArticle

Chen, Shih Ann ; Hsieh, Ming Hsiung ; Tai, Ching Tai ; Tsai, Chin Feng ; Prakash, V. S. ; Yu, Wen Chung ; Hsu, Tsui Lieh ; Ding, Yu An ; Chang, Mau Song. / Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins : Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. In: Circulation. 1999 ; Vol. 100, No. 18. pp. 1879-1886.
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abstract = "Background - Atrial fibrillation (AF) can be initiated by ectopic beats originating from the atrial or great venous tissues. This study investigated the anatomic characteristics and electrophysiological properties of pulmonary veins (PVs), as well as the possible mechanisms and response to drugs of ectopic foci, and assessed the effects of radiofrequency (RF) ablation on AF initiated by ectopic beats originating from PVs. Methods and Results - Seventy-nine patients with frequent episodes of paroxysmal AF and 10 control patients were included. Distal PVs showed the shortest effective refractory periods (ERPs), and right superior PVs showed a higher incidence of intra-PV conduction block than left superior PVs. Superior and left PVs had longer myocardial sleeves than inferior and right PVs, respectively. These electrophysiological characteristics were similar between AF and control patients. Propranolol, verapamil, and procainamide suppressed ectopic beats that originated from the PVs. Of 116 ectopic foci that initiated AF, 103 (88.8{\%}) originated from PVs. A mean of 7±3 RF applications completely eliminated 110 ectopic foci (94.8{\%}). During the 6±2-month follow-up period, 68 patients (86.1{\%}) were free of AF without any antiarrhythmic drugs. Follow- up transesophageal echocardiogram showed 42.4{\%} of ablated PVs had focal stenosis. One patient had mild exertional dyspnea after ablation, but it resolved 3 months later; 1 patient had onset of mild exertional dyspnea 5 months after ablation. Conclusions - Electrophysiological characteristics of PVs are different from those in the atria. Ectopic beats from PVs can initiate AF, and β-adrenergic receptor blocker, calcium channel blockers, and sodium channel blockers can suppress these ectopic beats. Careful mapping and elimination of these ectopic foci can cure paroxysmal AF.",
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T1 - Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins

T2 - Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation

AU - Chen, Shih Ann

AU - Hsieh, Ming Hsiung

AU - Tai, Ching Tai

AU - Tsai, Chin Feng

AU - Prakash, V. S.

AU - Yu, Wen Chung

AU - Hsu, Tsui Lieh

AU - Ding, Yu An

AU - Chang, Mau Song

PY - 1999/11/2

Y1 - 1999/11/2

N2 - Background - Atrial fibrillation (AF) can be initiated by ectopic beats originating from the atrial or great venous tissues. This study investigated the anatomic characteristics and electrophysiological properties of pulmonary veins (PVs), as well as the possible mechanisms and response to drugs of ectopic foci, and assessed the effects of radiofrequency (RF) ablation on AF initiated by ectopic beats originating from PVs. Methods and Results - Seventy-nine patients with frequent episodes of paroxysmal AF and 10 control patients were included. Distal PVs showed the shortest effective refractory periods (ERPs), and right superior PVs showed a higher incidence of intra-PV conduction block than left superior PVs. Superior and left PVs had longer myocardial sleeves than inferior and right PVs, respectively. These electrophysiological characteristics were similar between AF and control patients. Propranolol, verapamil, and procainamide suppressed ectopic beats that originated from the PVs. Of 116 ectopic foci that initiated AF, 103 (88.8%) originated from PVs. A mean of 7±3 RF applications completely eliminated 110 ectopic foci (94.8%). During the 6±2-month follow-up period, 68 patients (86.1%) were free of AF without any antiarrhythmic drugs. Follow- up transesophageal echocardiogram showed 42.4% of ablated PVs had focal stenosis. One patient had mild exertional dyspnea after ablation, but it resolved 3 months later; 1 patient had onset of mild exertional dyspnea 5 months after ablation. Conclusions - Electrophysiological characteristics of PVs are different from those in the atria. Ectopic beats from PVs can initiate AF, and β-adrenergic receptor blocker, calcium channel blockers, and sodium channel blockers can suppress these ectopic beats. Careful mapping and elimination of these ectopic foci can cure paroxysmal AF.

AB - Background - Atrial fibrillation (AF) can be initiated by ectopic beats originating from the atrial or great venous tissues. This study investigated the anatomic characteristics and electrophysiological properties of pulmonary veins (PVs), as well as the possible mechanisms and response to drugs of ectopic foci, and assessed the effects of radiofrequency (RF) ablation on AF initiated by ectopic beats originating from PVs. Methods and Results - Seventy-nine patients with frequent episodes of paroxysmal AF and 10 control patients were included. Distal PVs showed the shortest effective refractory periods (ERPs), and right superior PVs showed a higher incidence of intra-PV conduction block than left superior PVs. Superior and left PVs had longer myocardial sleeves than inferior and right PVs, respectively. These electrophysiological characteristics were similar between AF and control patients. Propranolol, verapamil, and procainamide suppressed ectopic beats that originated from the PVs. Of 116 ectopic foci that initiated AF, 103 (88.8%) originated from PVs. A mean of 7±3 RF applications completely eliminated 110 ectopic foci (94.8%). During the 6±2-month follow-up period, 68 patients (86.1%) were free of AF without any antiarrhythmic drugs. Follow- up transesophageal echocardiogram showed 42.4% of ablated PVs had focal stenosis. One patient had mild exertional dyspnea after ablation, but it resolved 3 months later; 1 patient had onset of mild exertional dyspnea 5 months after ablation. Conclusions - Electrophysiological characteristics of PVs are different from those in the atria. Ectopic beats from PVs can initiate AF, and β-adrenergic receptor blocker, calcium channel blockers, and sodium channel blockers can suppress these ectopic beats. Careful mapping and elimination of these ectopic foci can cure paroxysmal AF.

KW - Ablation

KW - Electrophysiology

KW - Fibrillation

KW - Veins

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