Noninvasive vectorcardiographic evaluation of pulmonary vein-atrial reconnection after pulmonary vein isolation for atrial fibrillation

BACKGROUND Although pulmonary vein (PV)-left atrium (LA) reconnection is associated with recurrence of atrial fibrillation (AF) in patients who undergo pulmonary vein isolation (PVI), no noninvasive method for evaluating PV reconnection has yet been established. OBJECTIVE The purpose of this study was to examine whether PV-LA reconnection could be detected noninvasively by analyzing the change of P-loop configuration by vectorcardiography (VCG). METHODS The study included 80 patients with paroxysmal AF (8 female; mean age 58 +/- 10 years) who underwent PVI. VCG was prospectively analyzed by recording during the procedure (before and after PVI) and 1 year after the procedure to noninvasively evaluate PV-LA reconnection. RESULTS All patients showed a significant antero-leftward shift in the middle portion of the P loop on the horizontal plane of VCG, with an increase of the area within the P loop after the initial PVI (2.4 +/- 1.7 vs 4.6 +/- 2.7 +/- 10(3) mV(2), P < .001). Sixty-three (78.8%) patients without AF recurrence demonstrated no remarkable change in the P-loop area after 16 +/- 11 months of follow-up (4.4 +/- 2.7 vs 4.1 +/- 2.5 +/- 10(3) mV(2), P < .51), whereas 17 (21.2%) patients with AF recurrence demonstrated P-loop reversion to the preprocedural P-loop morphology, with a decrease of P-loop area (5.6 +/- 2.7 vs 3.2 +/- 1.7 +/- 10(3) mV(2), P < .001). CONCLUSION Change of the P loop on VCG was associated with subsequent PV-LA reconnection. VCG is helpful as a noninvasive method for detecting PV-LA reconnection after PVI for paroxysmal AF.