Idiopathic paroxysmal atrial fibrillation induced by a focal discharge mechanism in the left superior pulmonary vein

Possible roles of the ligament of marshall

Chun Hwang, Hrayr S. Karagueuzian, Peng-Sheng Chen

Research output: Contribution to journalArticle

122 Citations (Scopus)

Abstract

Introduction: The origin of double potentials inside the left superior pulmonary vein and their relation to the mechanisms of idiopathic paroxysmal focal atrial fibrillation (AF) are unclear. Methods and Results: A total of 40 patients were studied. Group I included 15 patients who underwent radiofrequency catheter ablation of accessory pathway. Double potentials were found inside the left superior pulmonary vein during sinus rhythm in 10 patients and during premature atrial contractions in the remaining five patients. Group II included 25 patients with idiopathic paroxysmal AF. Double potentials were also identified in the left superior pulmonary vein. In 15 patients (Group IIA), the earliest automatic discharge during premature atrial contractions and at the onset of AF was within the left superior pulmonary vein. AF was ablated by radiofrequency energy application at the site registering double potentials. Radiofrequency ablation in the remaining 10 patients failed to terminate AF (Group IIB). The patients in Group IIA had significantly more male patients and more frequent premature atrial contractions and atrial tachycardia on 24-hour Holter recordings prior to the procedure than patients in Group IIB. Conclusions: Double potentials are present at the left superior pulmonary veins in patients with and without a history of AF. The first potential is due to the activation of atrial myocardium and the second is due to the activation of a different muscular structure. Rapid discharge of this structure triggers episodes of paroxysmal AF. Patients with focal AF originating from the left superior pulmonary vein can be identified by Holter recordings.

Original languageEnglish (US)
Pages (from-to)636-648
Number of pages13
JournalJournal of Cardiovascular Electrophysiology
Volume10
Issue number5
StatePublished - 1999
Externally publishedYes

Fingerprint

Pulmonary Veins
Ligaments
Atrial Fibrillation
Atrial Premature Complexes
carbosulfan
Catheter Ablation
Tachycardia
Myocardium

Keywords

  • Arrhythmia
  • Atrial fibrillation
  • Myocardial diseases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

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title = "Idiopathic paroxysmal atrial fibrillation induced by a focal discharge mechanism in the left superior pulmonary vein: Possible roles of the ligament of marshall",
abstract = "Introduction: The origin of double potentials inside the left superior pulmonary vein and their relation to the mechanisms of idiopathic paroxysmal focal atrial fibrillation (AF) are unclear. Methods and Results: A total of 40 patients were studied. Group I included 15 patients who underwent radiofrequency catheter ablation of accessory pathway. Double potentials were found inside the left superior pulmonary vein during sinus rhythm in 10 patients and during premature atrial contractions in the remaining five patients. Group II included 25 patients with idiopathic paroxysmal AF. Double potentials were also identified in the left superior pulmonary vein. In 15 patients (Group IIA), the earliest automatic discharge during premature atrial contractions and at the onset of AF was within the left superior pulmonary vein. AF was ablated by radiofrequency energy application at the site registering double potentials. Radiofrequency ablation in the remaining 10 patients failed to terminate AF (Group IIB). The patients in Group IIA had significantly more male patients and more frequent premature atrial contractions and atrial tachycardia on 24-hour Holter recordings prior to the procedure than patients in Group IIB. Conclusions: Double potentials are present at the left superior pulmonary veins in patients with and without a history of AF. The first potential is due to the activation of atrial myocardium and the second is due to the activation of a different muscular structure. Rapid discharge of this structure triggers episodes of paroxysmal AF. Patients with focal AF originating from the left superior pulmonary vein can be identified by Holter recordings.",
keywords = "Arrhythmia, Atrial fibrillation, Myocardial diseases",
author = "Chun Hwang and Karagueuzian, {Hrayr S.} and Peng-Sheng Chen",
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TY - JOUR

T1 - Idiopathic paroxysmal atrial fibrillation induced by a focal discharge mechanism in the left superior pulmonary vein

T2 - Possible roles of the ligament of marshall

AU - Hwang, Chun

AU - Karagueuzian, Hrayr S.

AU - Chen, Peng-Sheng

PY - 1999

Y1 - 1999

N2 - Introduction: The origin of double potentials inside the left superior pulmonary vein and their relation to the mechanisms of idiopathic paroxysmal focal atrial fibrillation (AF) are unclear. Methods and Results: A total of 40 patients were studied. Group I included 15 patients who underwent radiofrequency catheter ablation of accessory pathway. Double potentials were found inside the left superior pulmonary vein during sinus rhythm in 10 patients and during premature atrial contractions in the remaining five patients. Group II included 25 patients with idiopathic paroxysmal AF. Double potentials were also identified in the left superior pulmonary vein. In 15 patients (Group IIA), the earliest automatic discharge during premature atrial contractions and at the onset of AF was within the left superior pulmonary vein. AF was ablated by radiofrequency energy application at the site registering double potentials. Radiofrequency ablation in the remaining 10 patients failed to terminate AF (Group IIB). The patients in Group IIA had significantly more male patients and more frequent premature atrial contractions and atrial tachycardia on 24-hour Holter recordings prior to the procedure than patients in Group IIB. Conclusions: Double potentials are present at the left superior pulmonary veins in patients with and without a history of AF. The first potential is due to the activation of atrial myocardium and the second is due to the activation of a different muscular structure. Rapid discharge of this structure triggers episodes of paroxysmal AF. Patients with focal AF originating from the left superior pulmonary vein can be identified by Holter recordings.

AB - Introduction: The origin of double potentials inside the left superior pulmonary vein and their relation to the mechanisms of idiopathic paroxysmal focal atrial fibrillation (AF) are unclear. Methods and Results: A total of 40 patients were studied. Group I included 15 patients who underwent radiofrequency catheter ablation of accessory pathway. Double potentials were found inside the left superior pulmonary vein during sinus rhythm in 10 patients and during premature atrial contractions in the remaining five patients. Group II included 25 patients with idiopathic paroxysmal AF. Double potentials were also identified in the left superior pulmonary vein. In 15 patients (Group IIA), the earliest automatic discharge during premature atrial contractions and at the onset of AF was within the left superior pulmonary vein. AF was ablated by radiofrequency energy application at the site registering double potentials. Radiofrequency ablation in the remaining 10 patients failed to terminate AF (Group IIB). The patients in Group IIA had significantly more male patients and more frequent premature atrial contractions and atrial tachycardia on 24-hour Holter recordings prior to the procedure than patients in Group IIB. Conclusions: Double potentials are present at the left superior pulmonary veins in patients with and without a history of AF. The first potential is due to the activation of atrial myocardium and the second is due to the activation of a different muscular structure. Rapid discharge of this structure triggers episodes of paroxysmal AF. Patients with focal AF originating from the left superior pulmonary vein can be identified by Holter recordings.

KW - Arrhythmia

KW - Atrial fibrillation

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