Where to Perform the Pulmonary Vein Isolation in Third-Ablation Paroxysmal AF?
Juan Xu, Tong Wei, Lin Liang et al.
✦ AI-curated · Sources linked
Case in brief
A 52-year-old woman underwent a third ablation for paroxysmal atrial fibrillation. Mapping found that the pulmonary vein ostia were isolated, whereas the pulmonary vein antra were not. During circumferential antral ablation, the atrial arrhythmias were eliminated; an empiric roof line and superior vena cava isolation were also performed. She remained free of arrhythmias without antiarrhythmic drugs during 84-month follow-up.
What made this case unusual
Despite apparently durable ostial pulmonary vein isolation, mapping identified persistent electrical conduction at the pulmonary vein antra in a patient with recurrent atrial fibrillation.
Diagnostic / clinical pearl
In recurrent atrial fibrillation after ostial pulmonary vein isolation, assess whether the pulmonary vein antra are also electrically isolated.