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Published on: October 28, 2020
Confined thoracic vein fibrillation: prevalence and electrophysiological properties
Shinsuke Miyazaki1, Shigeki Kusa1, Hiroshi Taniguchi1
1Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Insights
Confined thoracic vein fibrillation (cTVT) is a significant finding in atrial fibrillation (AF) patients, particularly those with paroxysmal AF. Eliminating cTVT through procedures like PV isolation leads to excellent clinical outcomes and freedom from AF.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Confined thoracic vein fibrillation (cTVT) is implicated as a driver of atrial fibrillation (AF).
- Limited understanding exists regarding the prevalence and characteristics of cTVT.
Purpose of the Study:
- To investigate the prevalence of cTVT in patients undergoing pulmonary vein (PV) isolation for AF.
- To assess the clinical outcomes following the elimination of cTVT.
Main Methods:
- Analysis of 655 patients undergoing circumferential PV antrum isolation for AF.
- Identification and characterization of cTVT during the procedure.
- Follow-up assessment of arrhythmia recurrence and clinical outcomes.
Main Results:
- cTVT was identified in 4.3% of patients, significantly more common in paroxysmal AF (5.9%).
- cTVT occurred in PVs and the superior vena cava, with a median cycle length of 150 ms.
- Elimination of cTVT resulted in 92.9% of patients being AF-free post-procedure, with no recurrences in those treated with additional RF ablation.
Conclusions:
- Confined thoracic vein fibrillation is a notable finding in paroxysmal AF patients.
- Eliminating cTVT through targeted ablation yields highly successful clinical outcomes.
Introduction:
Confined thoracic vein fibrillation (cTVT) is a finding that suggests that thoracic vein acts as a rapid driver to maintain atrial fibrillation (AF). However, little is known about the cTVT.
Methods And Results:
Among consecutive 655 patients (age 62 ± 0 years, 492 men, 421 paroxysmal) who underwent circumferential pulmonary vein (PV) antrum isolation for AF, cTVT was identified in 28 (4.3%) patients. The prevalence was significantly higher in patients with paroxysmal AF than in those with nonparoxysmal AF (5.9% vs 1.3%, P = .002). The cTVT was observed in left PVs in 15 (53.6%), right PVs in 11 (39.3%), and superior vena cava in 2 (7.1%) patients. The median cycle length of cTVT was 150 (110-170) ms. The cTVT was recognized when sinus rhythm was restored from AF during vein isolation in 14 patients. Dissociated activity was seen after the termination of cTVT in 23 (82.1%) patients, and cTVT reinitiated spontaneously after the dissociated activity. In 2 patients, AF was not terminated by multiple cardioversions before the isolation, even with a maximal energy delivery. At a median follow-up of 12.0 (7.5-20.5) months, 26 patients (92.9%) were free from AF without antiarrhythmic drugs after a mean of 1.4 ± 0.5 procedures per patient. Notably, recurrent arrhythmia was not observed in any patient (n = 6), wherein cTVT was terminated by additional radiofrequency applications inside an isolated area after the achievement of vein isolation.
Conclusions:
Confined thoracic vein fibrillation is not a rare finding in patients with paroxysmal AF, and its elimination results in an excellent clinical outcome.
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