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The case of a 65-year-old man with recurrent atrial fibrillation after undergoing segmental pulmonary vein isolation caused by the reconnection of previously isolated pulmonary veins is herein reported. Interestingly, frequent ectopic firings in the left superior pulmonary vein conducted to the left atrium, not through its ostium but through the supposed epicardial pathway at the region of the Marshall ligament, which had been absent during the first treatment session. The reisolation of the left superior pulmonary vein by radiofrequency application in the left atrial appendage thus successfully eliminated the occurrence of atrial fibrillation. [ABSTRACT FROM AUTHOR]

Background: Recent evidence has suggested that the transient re-conduction of the isolated pulmonary vein (PV) induced by the intravenous injection of adenosine (dormant PV conduction) might predict the incidence of subsequent venous reconnection after the procedure, which is the main cause of the atrial fibrillation (AF) recurrence after PV isolation (PVI). We tested the hypothesis that the elimination of these dormant PV conductions by additional radiofrequency (RF) applications can improve the efficacy of the PVI. Methods and Results: One hundred forty-eight patients (124 males; mean age 53 ± 9 years) with drug-refractory AF underwent the PVI procedure. The standard PVI was performed in 94 patients (Group A), whereas the elimination of adenosine triphosphate (ATP)-induced dormant conduction using additional RF energy was performed in addition to the standard PVI in other 54 patients (Group B). Dormant conduction was observed in 56% of the patients (30/54) in Group B and 95% of these transient re-conductions were successfully eliminated by additional RF applications (mean: 1.5 ± 1.0 times). During the mean follow-up period of 20 months, recurrences of AF after the procedures were observed significantly less frequently in Group B (20%) than in Group A (40%) (P < 0.05). Conclusion: The use of additional RF applications to eliminate transient PV reconnection induced by ATP injection led to a reduction of AF recurrence after PVI, most likely due to the minimization of the subsequent PV reconnection. [ABSTRACT FROM AUTHOR]

Background: Although the pulmonary veins have been demonstrated to play an important role in initiating and perpetuating atrial fibrillation, the role that cardiac muscle tissue in the pulmonary veins plays regarding the formation of P wave remains to be elucidated. We sought to clarify the contribution of pulmonary vein cardiac muscles to the formation of P waves by analyzing the P loops/waves in patients with atrial fibrillation. Methods: The subjects in this study consisted of 21 patients (mean age, 57 ± 10 years) with drug-refractory, paroxysmal atrial fibrillation who had undergone a segmental ostial isolation of all four pulmonary veins from the left atrium. Vectorcardiograms, intracardiac electrograms, and electrocardiograms (ECGs) were recorded before and after pulmonary vein isolation. Results: The morphology of P waves changed after pulmonary vein isolation procedures with a significant increase in the maximal amplitude of both the leftward force in lead x and the anterior force in lead z (P < 0.05). The middle part (second one of three parts) of P loop on the horizontal plane shifted anteriorly and leftward after pulmonary vein isolation. Intracardiac electrograms in the pulmonary veins demonstrated the averaged activation times of all four pulmonary veins to range from 40% to 84% of the P duration. Conclusions: The excitation of cardiac muscle tissue, which has migrated to the pulmonary veins, was thus found to play an important role in the formation of the middle part of the P wave/loop. [ABSTRACT FROM AUTHOR]

We report a case of a 46-year-old man with paroxysmal atrial fibrillation who underwent pulmonary vein isolation. After a complete isolation of each pulmonary vein was performed, two different types of pulmonary vein tachycardia appeared: a regular tachycardia in the left inferior pulmonary vein with a supposed reentrant mechanism, and an irregular tachycardia in the right superior PV showing a nonreentrant character. [ABSTRACT FROM AUTHOR]

Abstract: Herein we report a case of a patient presenting with paroxysmal atrial fibrillation (PAF) in whom the pulmonary veins (PVs) had a common inferior trunk and PV isolation at the common inferior trunk was successfully performed to prevent recurrence of PAR A 58-year-old man with drug-resistant PAF was referred to undergo curative treatment at our institution. A three-dimensional image of the PVs re-constructed by contrast-enhanced multi-detector computed tomography before the operation revealed a common inferior trunk of the PVs (24mm diameter). Segmental ostial PV isolation with the guidance of a circular mapping catheter was performed for both superior PVs and the common inferior PV trunk. All three PV ostia were successfully isolated from the LA, and the patient has been free from PAF thereafter for 18 months. Preprocedural multi-detector computed tomography or magnetic resonance imaging to evaluate the anatomy of PVs (the number, size, and shape) is thus considered to be useful for performing safe and smooth catheter ablation in patients with PAR [Copyright &y& Elsevier]

Abstract: Background: It is sometimes difficult to differentiate the transient appearance of atrial fibrillation (AF) after pulmonary vein (PV) isolation from a true recurrence of AF. We attempted to differentiate them by analyzing the time course after the procedure. Methods and Results: 79 patients who underwent PV isolation were divided into two groups (successful: N = 60 and unsuccessful: N = 19) according to the final outcome. Antiarrhythmic drugs were used either temporarily or continuously to treat re-appearance of AF after the procedure. The transient appearance of AF in the successful group gradually faded, while true AF recurrence in the unsuccessful group consistently increased in line with the follow-up (F/U) period. The appearance of AF after 3 months predicted a subsequent failure of the procedure with a positive/negative predictive value of 87/90%, respectively. Conclusion: Since the transient appearance of AF decreased and the true recurrence of AF increased in line with the F/U period, we should therefore wait at least 3 months before judging the outcome of PV isolation. [Copyright &y& Elsevier]