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.
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
Seth
S
McClennen
Michael
M
McLaughlin
Mark E
ME
Josephson
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