title: Pulmonary vein firing triggering atrial fibrillation after open heart surgery.
abstract: We report the case of a 44-year-old woman with obstructive hypertrophic cardiomyopathy without history of prior arrhythmias who underwent surgical myectomy. She developed symptomatic postoperative atrial fibrillation (AF) that was refractory to antiarrhythmic therapy and could not be adequately rate controlled. AF always was preceded by short and fast runs of atrial tachycardia. In the electrophysiology laboratory, this arrhythmia appeared to originate from the right superior pulmonary vein and conducted with variable degrees of exit block. Pulmonary vein isolation guided by circular mapping was performed, and no further episodes of either atrial tachycardia or AF were noted. This case highlights the potential role of the pulmonary veins in the pathophysiology of postoperative AF.
authors.affiliation: The Center for Atrial Fibrillation, Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, The Cleveland Clinic Foundation, Cleveland Ohio 44195, USA.
authors.forename: Eduardo B
authors.initials: EB
authors.lastname: Saad
authors.forename: Walid I
authors.initials: WI
authors.lastname: Saliba
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006801:Humans; D011667:Pulmonary Veins / Q000503:physiopathology*; D019233:Retreatment; D017211:Treatment Failure; D014463:Ultrasonography
chemical_list: D000889:Anti-Arrhythmia Agents