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Aims The aim of the study was to determine the level of pulmonary vein (PV) isolation achieved with the use of a novel radiofrequency circular multielectrode ablation catheter [pulmonary vein ablation catheter (PVAC)] in patients with paroxysmal atrial fibrillation. Although some efficacy data have been presented, the level of PV isolation, which is crucial both for efficacy and safety of the ablation, has not been defined with this new ablation catheter. Methods and results Detailed sinus rhythm voltage maps using an electroanatomic mapping system and projected on 3D computed tomography-derived reconstructions of the left atrium (LA) were obtained before and after PV isolation with the PVAC. Left atrium–PV entry and exit block was assessed for each vein. The population consisted of 12 patients, mean age 57 ± 6 years, seven male. After ablation, an extensive zone of potential reduction that included the ostium of each PV was observed in all patients. Bipolar voltages were significantly reduced in all PVs and in the LA close to the vein ostia, the mean voltage reduction was >80%. Conclusion Using the PVAC, (i) PVs are isolated at the level of the PV ostium and, importantly, outside the tubular portion and (ii) significant voltage reduction is also recorded at various extent proximal to the PV ostium at the level of the antral region.

The use of adenosine in unmasking potential 'trigger' activity in a patient with paroxysmal atrial fibrillation (AF) and persistent left superior vena cava (LSVC) has never been reported. In a 75-year-old woman with paroxysmal AF and LSVC anomaly, pulmonary vein isolation (PVI) procedure was performed. After successful PVI, repeated bolus adenosine infusions were given. Adenosine response originating from the LSVC was observed: it was reproducible, brief, and exhibited decremental atrial-to-LSVC conduction properties until cessation. Pacing from the LSVC resulted in atrial capture (confirming vein-to-atrium conduction). Disconnection of the LSVC from the coronary sinus (CS) was obtained by successfully ablating within the distal CS. Adenosine challenge may be important to identify AF triggers in non-PVI foci.

After previous pulmonary vein isolation and left atrial linear ablation for persistent atrial fibrillation (AF), a 70-year-old woman was referred for a redo procedure due to paroxysmal AF not controlled with antiarrhythmic drugs. Catheter movement induced AF that spontaneously went into an …