Induction of tachycardia confined within a pulmonary vein by electrical cardioversion of atrial fibrillation: Is it proof of reentry? Mauro Toniolo,

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Date of download: 7/11/2016 Copyright © The American College of Cardiology. All rights reserved. From: Electrogram polarity reversal as an additional indicator.

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Presentation transcript:

Induction of tachycardia confined within a pulmonary vein by electrical cardioversion of atrial fibrillation: Is it proof of reentry? Mauro Toniolo, MD, Jorge Figueroa, MD, Sergio Castrejòn-Castrejòn, MD, Jose Luis Merino, MD, PhD HeartRhythm Case Reports Volume 1, Issue 4, Pages 225-228 (July 2015) DOI: 10.1016/j.hrcr.2015.03.009 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Electrical disconnection of the left superior pulmonary vein (PV) by radiofrequency (RF) application. From top to bottom, the figure shows electrocardiogram lead aVF and intracardiac recordings at 100 mm/s from the ablation catheter (ABL1-2) placed at the left superior PV ostium, a circular 20-pole catheter (PV1-2 to PV19-20) placed within the left superior PV, and a tetrapolar catheter (CS1-2 and CS3-4) placed in the coronary sinus. RF application during ongoing atrial fibrillation (AF) results in the sudden disappearance of the PV electrogram (apparent on the recordings from all bipoles except PV11-12 and PV13-14) with AF persistence in the left atrium (LA) on the coronary sinus more apparent as far-field electrograms on the recordings from bipoles PV11-12 and PV13-14. The figure also shows a PV ectopic beat at the end of the tracing and a schematic showing the catheter position. A = atrium; LIPV = left inferior PV; LSPV = left superior PV; MA = mitral annulus. HeartRhythm Case Reports 2015 1, 225-228DOI: (10.1016/j.hrcr.2015.03.009) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 Tachycardia induction in the left superior pulmonary vein following direct current cardioversion. Atrial fibrillatory activity is replaced by sinus rhythm activity after cardioversion (arrow) on the recordings obtained from the coronary sinus and from bipoles PV9-10 to PV13-14 of the pulmonary vein catheter (far-field activation). Small far-field atrial fibrillatory activity is replaced by fibrillatory activity within the vein after cardioversion on the recordings from all bipoles but PV11-12 and PV13-14 (more apparent on bipoles PV3-4, PV5-6, and PV7-8). Abbreviations as defined in Figure 1. HeartRhythm Case Reports 2015 1, 225-228DOI: (10.1016/j.hrcr.2015.03.009) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 Tachycardia induction within the left superior pulmonary vein, with no conduction to the left atrium, by rapid pacing. Following pacing, sinus rhythm far-field activity is recorded from bipoles PV9-10, PV11-12, PV13-14 , and PV15-16 concurrently with fibrillatory activity within the pulmonary vein from bipoles PV1-2, PV15-16, and PV17-18. Abbreviations as defined in Figure 1. HeartRhythm Case Reports 2015 1, 225-228DOI: (10.1016/j.hrcr.2015.03.009) Copyright © 2015 Heart Rhythm Society Terms and Conditions