https://orcid.org/0000-0001-8229-3326
A 76-year-old man presented for catheter-based atrial fibrillation (AF) ablation. Sixteen years earlier, the patient had left-sided small cell lung cancer treated with chemotherapy and radiation. Left atrial mapping (Panels A and B) as well as contrast injections (Panel C) revealed complete occlusion of the proximal left superior pulmonary vein (PV). Following isolation of the right PVs, a spline-based multi-electrode catheter was positioned into the left superior PV stump. With infusion of isoproterenol up to 4 mcg/min, runs of triggered firing were appreciated from the left superior PV stump (Panel D). Following isolation of the left PVs, no arrhythmias remained inducible on isoproterenol up to 20 mcg/min. It is well appreciated that the PV muscle sleeves play a prominent role in the initiation of AF. Disruption of these sleeves might be predicted to reduce their triggering role but a prior report of patients post pneumonectomy found that PV stumps continue to be active triggering sites for AF. Our findings are somewhat unique in that our patient had no history of pneumonectomy but are in agreement with data that fully intact PV muscle sleeves are not necessary for the PV anatomy to trigger AF.
The full-length version of this report can be viewed at: https://www.escardio.org/Education/E-Learning/Clinical-cases/Electrophysiology.
