Maintenance of atrial fibrillation by pulmonary vein tachycardia with ostial conduction block: evidence of an interpulmonary vein electrical connection

J Cardiovasc Electrophysiol. 2008 Oct;19(10):1101-4. doi: 10.1111/j.1540-8167.2008.01141.x. Epub 2008 Mar 26.

Abstract

We report a case of a 56-year-old man with paroxysmal atrial fibrillation who underwent segmental, ostial pulmonary vein (PV) isolation while in arrhythmia. During isolation of the left superior PV (LSPV), organized electrical activity was seen within the vein, suggestive of a PV tachycardia with a cycle length of 90 ms. Simultaneously, organized electrical activity with a cycle length of 180 ms was seen in the left inferior PV (LIPV), suggestive of 2:1 conduction between the LSPV and the LIPV. Isolation of the LIPV resulted in conversion to sinus rhythm, while confirming isolation of the LSPV by the presence of ongoing PV tachycardia in this vein. This case demonstrates a direct electrical connection between the ipsilateral left PVs, leading to maintenance of atrial fibrillation.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / physiopathology*
  • Atrioventricular Block / diagnosis*
  • Atrioventricular Block / physiopathology*
  • Electrocardiography
  • Evidence-Based Medicine
  • Heart Conduction System / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Veins / physiopathology*