Slow whole left atrial conduction velocity after pulmonary vein isolation predicts atrial fibrillation recurrence

BACKGROUND Atrial conduction velocity may represent atrial fibrillation (AF) substrate after pulmonary vein isolation (PVI). To elucidate the association between whole left atrial conduction velocity (LACV) and AF recurrence after PVI. METHODS AND RESULTS This observational study enrolled 279 patients (147 paroxysmal and 132 persistent AF) who underwent PVI alone as an initial AF ablation procedure. After PVI, the left atrium was mapped with a 20-pole multielectrode in conjunction with the CARTO3 system during 100-ppm right atrial pacing. Left atrial conduction distance and conduction time were calculated from the start to the end of the propagation wave front in the left atrium. LACVs on the anterior and posterior routes were calculated as conduction distance divided by conduction time. Anterior and posterior LACVs were slower in patients with AF recurrence than in those without (anterior, 0.79 [0.71, 0.86] vs 0.96 [0.90, 1.06] m/s, P