Paroxysmal Fibrillation Within an Isolated Pulmonary Vein
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.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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