Two levels of block within a pulmonary vein.
We present a 37-year-old woman with drug refractory atrial fibrillation referred for a pulmonary vein (PV) isolation procedure who manifested a tachycardia with 2:1 intra-PV block within a dissociated PV. During ablation in the right superior PV, the surface rhythm became normal sinus, with persistent atrial fibrillation within the PV. Shortly thereafter, an atrial tachycardia with a cycle length of 190 ms and 2:1 distal to proximal exit block was observed within the isolated PV. Conduction block within a PV electrically isolated from the left atrium is a newly observed phenomenon that may have implications to the electrophysiologic properties of the PV muscular sleeves.
McClennen
Seth
S
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
McLaughlin
Michael
M
Josephson
Mark E
ME
D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013610:Tachycardia / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents