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(Circulation. 2002;106:1426.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Paroxysmal Fibrillation Within an Isolated Pulmonary Vein

Bradley P. Knight, MD; Hakan Oral, MD; Fred Morady, MD

From the Department of Internal Medicine, Division of Cardiology, University of Michigan Medical Center, Ann Arbor.

Correspondence to Bradley P. Knight, MD, University of Michigan Health System, 1500 East Medical Center Dr/B1F245, Ann Arbor, MI 48109-0022. E-mail bpk@umich.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 45-year-old man with idiopathic, paroxysmal atrial fibrillation underwent a pulmonary vein isolation catheter procedure. A decapolar ring catheter (Lasso) and a conventional 4-mm tip quadripolar ablation catheter were positioned in the proximal left superior pulmonary vein. A spontaneous episode of atrial fibrillation was triggered by a pulmonary vein depolarization recorded by electrodes 7 to 8 of the Lasso catheter (Figure 1). Four applications of radiofrequency energy at the ostium of the vein resulted in conversion to sinus rhythm, with ongoing fibrillation within the vein (Figure 2). The fibrillation continued to be paroxysmal and was initiated by the same pulmonary vein depolarization as before ablation (Figure 3). An application of radiofrequency energy within the vein at the site of origin of the pulmonary vein depolarization that initiated fibrillation eliminated the paroxysmal fibrillation. This case demonstrates that an arrhythmia that mimics atrial fibrillation can arise from the muscle sleeve that surrounds a pulmonary vein, and that this "pulmonary vein fibrillation" may be generated independent of any left atrial input.

View larger version (31K): [in this window] [in a new window]   Figure 1. Shown are leads I and V5 and intracardiac electrograms recorded by the ablation catheter (Abl bipolar and unipolar), the Lasso catheter (L1–2 to L10–1), and the distal and proximal coronary sinus catheter (CSd and CSp). The catheters were positioned in the left superior pulmonary vein near the ostium. A spontaneous episode of atrial fibrillation was initiated by a pulmonary vein depolarization recorded by electrodes 7 to 8 (arrow).

View larger version (38K): [in this window] [in a new window]   Figure 2. The electrograms . . . [Full Text of this Article]