{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T13:56:35Z","timestamp":1762005395578,"version":"3.37.3"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,1,25]],"date-time":"2022-01-25T00:00:00Z","timestamp":1643068800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Ectopic beats originating from the pulmonary vein (PV) trigger atrial fibrillation (AF). The purpose of this study was to clarify the electrophysiological determinant of AF initiation from the PVs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Pacing studies were performed with a single extra stimulus mimicking an ectopic beat in the left superior PVs (LSPVs) in 62 patients undergoing AF ablation. Inducibility of AF, effective refractory period (ERP), and conduction properties within the PVs were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A single extra stimulus in LSPV induced AF in 20 patients (32% of all patients) at the mean coupling interval (CI) of 172\u2009ms. A CI\u2010dependent anisotropic conduction at the AF onset was visualized in a three\u2010dimensional mapping. Onset of AF was site\u2010specific with reproducibility in each individual. Mean ERP in LSPV in the AF\u2010inducible group was shorter than that in the AF\u2010noninducible group (182\u2009\u00b1\u200955\u00a0vs. 254\u2009\u00b1\u200951\u2009ms, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001). LSPV ERP dispersion was greater in the AF\u2010inducible group than in the AF\u2010noninducible group (45\u2009\u00b1\u200928\u00a0vs. 27\u2009\u00b1\u200919 ms, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01). Circumferential intra\u2010PV conduction time (IPVCT) exhibited decremental properties in response to shortening of CI\u00a0and the prolongation of IPVCT in the AF\u2010inducible site was greater than that in the AF\u2010noninducible site (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05) in each individual.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Location and CI of an ectopic excitation ultimately determine the initiation of AF from the PVs. ERP dispersion\u00a0and circumferential conduction delay may lead to anisotropic conduction and reentry within the PVs that initiate AF.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15371","type":"journal-article","created":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T03:06:11Z","timestamp":1642647971000},"page":"629-637","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Location and coupling interval of an ectopic excitation determine the initiation of atrial fibrillation from the pulmonary veins"],"prefix":"10.1111","volume":"33","author":[{"given":"Shunsuke","family":"Kawai","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Japanese Red Cross Fukuoka Hospital  Fukuoka Japan"},{"name":"Department of Cardiovascular Medicine Kyushu University Graduate School of Medical Sciences  Fukuoka 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