Focal atrial fibrillation associated with multiple breakout sites at the crista terminalis.
A 34-year-old man with permanent atrial fibrillation (AF) underwent electrophysiologic testing. Spontaneous AF was observed even after successful pulmonary vein (PV) isolation of all four PVs. Intracardiac electrograms recorded from a basket catheter deployed around the crista terminalis during triggered atrial premature beats exhibited low-amplitude potentials which were suggested to reflect focal ectopic activity, preceding high-frequency atrial potentials. The firing from those focal activity sites induced a shift in the breakout sites and conduction block to the right atrium, which suggested the participation of preferential conduction. Radiofrequency catheter ablation targeting the focal origin and preferential conduction sites eliminated the AF.
Yamada
Takumi
T
Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan. takumi-y@fb4.so-net.ne.jp
Murakami
Yoshimasa
Y
Okada
Taro
T
Murohara
Toyoaki
T
D000328:Adult; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011667:Pulmonary Veins / Q000503:physiopathology*