Electrical Excitation of the Pulmonary Venous Musculature May Contribute to the Formation of the Last Component of the High Frequency Signal of the P Wave

Pulmonary veins (PVs) have been shown to play an important role in the induction and perpetuation of focal AF. Fifty-one patients with AF, and 24 patients without AF as control subjects, were enrolled in this study. Signal-averaged P-wave recording was performed, and the filtered P wave duration (FPD), the root-mean-square voltage for the last 20, 30 and 40 ms (RMS20, 30, and 40, respectively) were compared. In 7 patients with AF, these parameters were compared before and after the catheter ablation. The FPD was significantly longer and the RMS20 was smaller in the patients with AF than those without AF. Because RMS30 was widely distributed between 2 and 10 µV, the AF group was sub-divided into two groups; Group 1 was comprised of the patients with an RMS30 ≧5.0 µV, and group 2, <5.0 µV. In group 1, short-coupled PACs were more frequently documented on Holter monitoring, and exercise testing more readily induced AF. After successful electrical disconnection between the LA and PVs, each micropotential parameter was significantly attenuated. These results indicate that the high frequency signal amplitude of the last component of the P wave is relatively high in patients with AF triggered by focal repetitive excitations most likely originating from the PVs. That is, attenuation by the LA-PV electrical isolation, and thus the high frequency P signals of the last component, may contain the electrical excitation of the PV musculature