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We hypothesized that PV firing (PV\u2010F) should continue after circumferential PV isolation (CPVI) because the PV tissue responsible for PV\u2010F remains intact.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>In Group\u20101 (n = 92), isoproterenol (ISP) and adenosine triphosphate (ATP) were co\u2010administered to provoke PV\u2010F before and after CPVI. The site of rapid focal discharge that initiated atrial fibrillation (AF) defined PV\u2010F versus non\u2010PV\u2010F. Additional 17 patients with PV\u2010F induced by ISP+ATP before CPVI were enrolled into Group\u20102 and various pacing maneuvers were used in conjunction to ISP+ATP to provoke PV\u2010F after CPVI. In Group\u20101, AF was induced in 47\/81 (58.0%) and 16\/88 (18.2%) patients before and after CPVI, respectively (P &lt; 0.01). Before CPVI, 43\/47 (91.5%) of the rapid firing originated from PV. After successful CPVI, 88\/92 patients were in sinus rhythm and non\u2010PV\u2010F was induced in 14\/88 patients. PV\u2010F was induced in 2\/88 patients, which was eliminated by ganglionated plexus ablation outside the CPVI line. In Group\u20102, various pacing maneuvers with ISP+ATP only induced PV\u2010F in 1\/17 patients after CPVI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Marked suppression of PV\u2010F after CPVI strongly suggests that the real source of PV\u2010F is located in the atrium. PV\u2010F may be an epiphenomenon.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.12288","type":"journal-article","created":{"date-parts":[[2013,9,12]],"date-time":"2013-09-12T15:02:38Z","timestamp":1378998158000},"page":"111-118","source":"Crossref","is-referenced-by-count":18,"title":["Marked Suppression of Pulmonary Vein Firing After Circumferential Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation: Is Pulmonary Vein Firing an Epiphenomenon?"],"prefix":"10.1111","volume":"25","author":[{"given":"RU\u2010HONG","family":"JIANG","sequence":"first","affiliation":[{"name":"Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University  Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CHEN\u2010YANG","family":"JIANG","sequence":"additional","affiliation":[{"name":"Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University  Hangzhou 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