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Europace 2002 4(4):411-415; doi:10.1053/eupc.2002.0254
© 2002 by European Society of Cardiology
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CASE REPORT

Decremental intravenous pulse propagation during extrastimulus pacing: relevance for catheter ablation of focal atrial fibrillation

T. Lewalter1, D. Burkhardt1, S. Chun2, R. Schimpf1, H. Bielik1, J. Schrickel1, N. Shlevkov1, A. Yang1 and B. Lüderitz1

1Department of Medicine-Cardiology, University of Bonn Sigmund-Freud-Str. 25, 53105, Bonn, Germany; 2Stanford University, Medical Center, Division of Cardiovascular Medicine 300 Pasteur Drive, H2146, Stanford, CA 94305-5233, U.S.A.

We report a case study demonstrating delayed circumferential intrapulmonary-venous conduction characteristics during coronary sinus extrastimulus pacing. This phenomenon allowed the unmasking and discrimination of a localized left atrial to PV breakthrough from secondarily activated PV muscle in a common left-sided PV ostium. Thus, this pacing manoeuvre may serve to guide RF delivery in the treatment of focal AF.

Key Words: Arrhythmia, atrial fibrillation, catheter ablation, mapping, pulmonary vein

Correspondence: Thorsten Lewalter, MD, Assistant Professor of Medicine, Department of Medicine-Cardiology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. Tel.: +49 (228) 287-5507; Fax: +49 (228) 287-4983; E-mail: th.lewalter{at}uni-bonn.de

[1] Haïssaguerre M, Jaïs P, Shah D, Takahashi A, Hocini M, Quiniou G, Garrigue S, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659–666.[Abstract/Free Full Text]

[2] Haïssaguerre M, Shah D, Jaïs P, Hocini M, Yamane T, Deisenhofer I, Chauvin M, et al. Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation 2000; 102: 2463–2465.[Abstract/Free Full Text]

[3] Yu WC, Hsu TL, Tai CT, Tsai CF, Hsieh MH, Lin WS, Lin YK, et al. Acquired pulmonary vein stenosis after radiofrequency catheter ablation of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2001; 12: 887–892.[CrossRef][Web of Science][Medline]

[4] Gerstenfeld EP, Guerra P, Sparks PB, Hattori K, Lesh MD. Clinical outcome after radiofrequency catheter ablation of focal atrial fibrillation triggers. J Cardiovasc Electrophysiol 2001; 12: 900–908.[CrossRef][Web of Science][Medline]

[5] Hocini M, Shah DC, Jaïs P, Haïssaguerre M, Peng JT, Yamane T, Deisenhofer I, et al. Concealed left pulmonary vein potentials unmasked by left atrial stimulation. Pacing Clin Electrophysiol 2000; 23: 1832–1835.[Medline]

[6] Ho SY, Cabrera JA, Tran VH, Farré J, Anderson RH, Sánchez-Quintana D. Architecture of the pulmonary veins: relevance to radiofrequency ablation. Heart 2001; 86: 265–270.[Abstract/Free Full Text]


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This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
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ISI Web of Science (1)
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