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Is This Pulmonary Vein Isolated?
I s T h i s P u l m o n a r y Ve i n Isolated? Fred Morady, MD KEYWORDS Pulmonary vein Atrium Left superior pulmonary vein Atrial fibrillation Catheter ablation
KEY POINTS
CASE HISTORY
COMMENTARY
Circumferential antral ablation was performed in a 56-year-old man with paroxysmal atrial fibrillation. The electrograms shown in Fig. 1 were recorded after circumferential ablation around the left superior pulmonary vein (LSPV). Is this pulmonary vein electrically isolated from the left atrium?
There is slow automatic activity arising in the LSPV, and this activity is dissociated from the sinus beats, indicating that there is complete entrance block. However, depending on the coupling interval between the last sinus beat and the pulmonary vein potentials, there is conduction
Fig. 1. Electrograms recorded with a ring catheter within the left superior pulmonary vein after circumferential antral ablation. The ablation catheter was positioned in the body of the left atrium. Abl, ablation catheter; cs, coronary sinus; d, distal; p, proximal. University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA E-mail address: [email protected] Card Electrophysiol Clin 4 (2012) 571–572 http://dx.doi.org/10.1016/j.ccep.2012.08.015 1877-9182/12/$ – see front matter Ó 2012 Elsevier Inc. All rights reserved.
cardiacEP.theclinics.com
Unidirectional block is infrequent in pulmonary veins but is important to recognize because it may be responsible for recurrent atrial fibrillation after catheter ablation. If there is no automatic activity arising in a pulmonary vein after isolation, the only way to recognize unidirectional block is to pace inside the pulmonary vein through the electrodes of a ring catheter to look for conduction to the atrium.
572
Morady
Fig. 2. The arrow marks the pulmonary vein potentials that are conducted from the left superior pulmonary vein to the left atrium, resulting in a premature atrial depolarization (asterisk).
from the LSPV to the left atrium, resulting in a premature atrial depolarization (Fig. 2). Therefore, this pulmonary vein is not completely isolated. This case is an example of unidirectional block in a pulmonary vein. Unidirectional block is infrequent in pulmonary veins but is important to recognize
because it may be responsible for recurrent atrial fibrillation after catheter ablation. If there is no automatic activity arising in a pulmonary vein after isolation, the only way to recognize unidirectional block is to pace inside the pulmonary vein through the electrodes of a ring catheter to look for conduction to the atrium.
KEY POINTS
CASE HISTORY
COMMENTARY
Circumferential antral ablation was performed in a 56-year-old man with paroxysmal atrial fibrillation. The electrograms shown in Fig. 1 were recorded after circumferential ablation around the left superior pulmonary vein (LSPV). Is this pulmonary vein electrically isolated from the left atrium?
There is slow automatic activity arising in the LSPV, and this activity is dissociated from the sinus beats, indicating that there is complete entrance block. However, depending on the coupling interval between the last sinus beat and the pulmonary vein potentials, there is conduction
Fig. 1. Electrograms recorded with a ring catheter within the left superior pulmonary vein after circumferential antral ablation. The ablation catheter was positioned in the body of the left atrium. Abl, ablation catheter; cs, coronary sinus; d, distal; p, proximal. University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA E-mail address: [email protected] Card Electrophysiol Clin 4 (2012) 571–572 http://dx.doi.org/10.1016/j.ccep.2012.08.015 1877-9182/12/$ – see front matter Ó 2012 Elsevier Inc. All rights reserved.
cardiacEP.theclinics.com
Unidirectional block is infrequent in pulmonary veins but is important to recognize because it may be responsible for recurrent atrial fibrillation after catheter ablation. If there is no automatic activity arising in a pulmonary vein after isolation, the only way to recognize unidirectional block is to pace inside the pulmonary vein through the electrodes of a ring catheter to look for conduction to the atrium.
572
Morady
Fig. 2. The arrow marks the pulmonary vein potentials that are conducted from the left superior pulmonary vein to the left atrium, resulting in a premature atrial depolarization (asterisk).
from the LSPV to the left atrium, resulting in a premature atrial depolarization (Fig. 2). Therefore, this pulmonary vein is not completely isolated. This case is an example of unidirectional block in a pulmonary vein. Unidirectional block is infrequent in pulmonary veins but is important to recognize
because it may be responsible for recurrent atrial fibrillation after catheter ablation. If there is no automatic activity arising in a pulmonary vein after isolation, the only way to recognize unidirectional block is to pace inside the pulmonary vein through the electrodes of a ring catheter to look for conduction to the atrium.