© 2003 by European Society of Cardiology
IMAGES IN ELECTROPHYSIOLOGY
Isolation of atrial fibrillation to a pulmonary vein
Cardiovascular Division, Beth Israel Deaconess Medical Center Boston, MA 02446, USA
Manuscript submitted 3 June 2003. Accepted after revision 22 June 2003.
Correspondence: Dr Mark E. Josephson, Cardiovascular Division, Department of Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Baker 4, Boston, MA 02446, U.S.A. Tel.: +1-617-632-7457; Fax: +1-617-632-7620. E-mail: mjoseph2{at}caregroup.harvard.edu
Key Words: Atrial fibrillation, pulmonary vein isolation, ablation, endocardial mapping
This is a 37-year-old woman with paroxysmal atrial fibrillation (AF) for 1.5 years. She has had symptomatic recurrences (palpitations and syncope) despite flecainide ± beta blockers and sotalol. An electrophysiological study elsewhere found AF initiated by atrial tachyarrhythmias originating in the right superior pulmonary vein. Multiple ablations (>40) failed to stop AF. She was sent to us. We demonstrated that she had six pulmonary veins (three on each side) which essentially had two giant common ostia. Isolation of the left veins did not affect AF. During an isolation attempt of the right pulmonary veins, she went into sinus rhythm, but the lasso catheter, which lay just inside the upper part of the common ostium revealed AF which continued in the isolated vein despite sinus rhythm controlling the body of both atria.
Figure 1 demonstrates the pulmonary veins as defined by electroanatomic mapping. The lasso is shown just inside the right superior vein. The ablation catheter (curved arrow) is in the left atrium. The analogue recording shows sinus rhythm in the distal and proximal poles of the ablation catheter (abl), while the 10 bipolar signals from the lasso show AF.
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