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Erschienen in:
03.06.2020 | Case Reports
An unusual response of pulmonary vein bigeminy to antral ablation
Erschienen in: Journal of Interventional Cardiac Electrophysiology | Ausgabe 3/2020
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A 70-year-old-male patient underwent cryoballoon pulmonary vein (PV) isolation to treat drug-resistant paroxysmal atrial fibrillation (AF). During cryoablation of the left lower pulmonary vein (LLPV) antrum, the Achieve catheter recorded two potentials inside the LLPV (Fig. 1), previously reported as PV bigeminy [1]. The inter-potential interval was stable during each beat.
Fig. 1
a Non-selective left lower pulmonary vein (LLPV) angiogram in left anterior oblique view. Two distinct branches are noted (upper and lower). The decapolar catheter is placed in the coronary sinus. b The Arctic Front Advance Cryoballoon is used to occlude the LLPV with the Achieve Advance Mapping Catheter inside the lower branch of the LLPV. The solid arrow indicates pole-4 of the Achieve catheter at the bifurcation of the LLPV. c Intracardiac electrograms (EGMs) during sinus rhythm showing activation of the inferior aspect of the LLPV (from PV 1–2 to PV 4–5) with sharp EGMs between far-field atrial and ventricular EGMs and opposite activation of the same bipoles with sharp EGMs recorded after the ventricular far-field EGMs. The timing of both PVP1 (solid arrow) and PVP2 (dashed arrow) is stable with fixed inter-PVP interval on each bipole. The third beat shows disappearance of PVP2 with perseverance of PVP1. LLPV-LB: Left lower pulmonary vein lower branch, LLPV-UB: Left lower pulmonary vein upper branch, LUPV: Left upper pulmonary vein
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