Cargando…

What are the post-ablation insular residual electrograms in the posterior left pulmonary veins electrically connected to?

A 67-year-old man underwent a third ablation procedure for a recurrent atrial tachycardia (AT) after an extensive pulmonary vein (PV) isolation, linear ablation along the left atrial (LA) roof and posterolateral mitral isthmus (MI), and defragmentation of persistent atrial fibrillation and an induce...

Descripción completa

Detalles Bibliográficos
Autores principales: Nakamura, Kohki, Takigawa, Masateru, Sasaki, Takehito, Minami, Kentaro, Naito, Shigeto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263333/
https://www.ncbi.nlm.nih.gov/pubmed/33965551
http://dx.doi.org/10.1016/j.ipej.2021.04.008
_version_ 1783719370074095616
author Nakamura, Kohki
Takigawa, Masateru
Sasaki, Takehito
Minami, Kentaro
Naito, Shigeto
author_facet Nakamura, Kohki
Takigawa, Masateru
Sasaki, Takehito
Minami, Kentaro
Naito, Shigeto
author_sort Nakamura, Kohki
collection PubMed
description A 67-year-old man underwent a third ablation procedure for a recurrent atrial tachycardia (AT) after an extensive pulmonary vein (PV) isolation, linear ablation along the left atrial (LA) roof and posterolateral mitral isthmus (MI), and defragmentation of persistent atrial fibrillation and an induced perimitral AT. High-resolution mapping during the clinical AT using the Rhythmia system (Boston Scientific) suggested that the AT was a ridge-related reentrant AT and exhibited a reconnection of the left PVs (LPVs). The residual electrograms in the posterior LPVs were surrounded by endocardial scar, which was like an island consisting of residual LPV electrograms. Retrograde venography of the vein of Marshall (VOM) demonstrated that the VOM reached the posterior left superior PV through the ridge between the LA appendage and left inferior PV and then the LPV carina. An ethanol infusion into the VOM resulted in a simultaneous AT termination and complete electrical isolation of the LPVs, that is, the disappearance of the residual LPV electrograms. The insular residual LPV electrograms in the present case did not appear to be endocardially connected to the LA, because the LPV electrograms were surrounded by endocardial scar and there was a large time gap between the earliest activation in the posterior LPVs and activation in the surrounding area. The VOM course on the venography and elimination of the residual LPV electrograms with an ethanol infusion into the VOM suggested that the insular residual LPV electrograms were electrically connected to the posterolateral LA via the VOM and its branches.
format Online
Article
Text
id pubmed-8263333
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-82633332021-07-16 What are the post-ablation insular residual electrograms in the posterior left pulmonary veins electrically connected to? Nakamura, Kohki Takigawa, Masateru Sasaki, Takehito Minami, Kentaro Naito, Shigeto Indian Pacing Electrophysiol J Case Report A 67-year-old man underwent a third ablation procedure for a recurrent atrial tachycardia (AT) after an extensive pulmonary vein (PV) isolation, linear ablation along the left atrial (LA) roof and posterolateral mitral isthmus (MI), and defragmentation of persistent atrial fibrillation and an induced perimitral AT. High-resolution mapping during the clinical AT using the Rhythmia system (Boston Scientific) suggested that the AT was a ridge-related reentrant AT and exhibited a reconnection of the left PVs (LPVs). The residual electrograms in the posterior LPVs were surrounded by endocardial scar, which was like an island consisting of residual LPV electrograms. Retrograde venography of the vein of Marshall (VOM) demonstrated that the VOM reached the posterior left superior PV through the ridge between the LA appendage and left inferior PV and then the LPV carina. An ethanol infusion into the VOM resulted in a simultaneous AT termination and complete electrical isolation of the LPVs, that is, the disappearance of the residual LPV electrograms. The insular residual LPV electrograms in the present case did not appear to be endocardially connected to the LA, because the LPV electrograms were surrounded by endocardial scar and there was a large time gap between the earliest activation in the posterior LPVs and activation in the surrounding area. The VOM course on the venography and elimination of the residual LPV electrograms with an ethanol infusion into the VOM suggested that the insular residual LPV electrograms were electrically connected to the posterolateral LA via the VOM and its branches. Elsevier 2021-05-13 /pmc/articles/PMC8263333/ /pubmed/33965551 http://dx.doi.org/10.1016/j.ipej.2021.04.008 Text en © 2021 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Nakamura, Kohki
Takigawa, Masateru
Sasaki, Takehito
Minami, Kentaro
Naito, Shigeto
What are the post-ablation insular residual electrograms in the posterior left pulmonary veins electrically connected to?
title What are the post-ablation insular residual electrograms in the posterior left pulmonary veins electrically connected to?
title_full What are the post-ablation insular residual electrograms in the posterior left pulmonary veins electrically connected to?
title_fullStr What are the post-ablation insular residual electrograms in the posterior left pulmonary veins electrically connected to?
title_full_unstemmed What are the post-ablation insular residual electrograms in the posterior left pulmonary veins electrically connected to?
title_short What are the post-ablation insular residual electrograms in the posterior left pulmonary veins electrically connected to?
title_sort what are the post-ablation insular residual electrograms in the posterior left pulmonary veins electrically connected to?
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263333/
https://www.ncbi.nlm.nih.gov/pubmed/33965551
http://dx.doi.org/10.1016/j.ipej.2021.04.008
work_keys_str_mv AT nakamurakohki whatarethepostablationinsularresidualelectrogramsintheposteriorleftpulmonaryveinselectricallyconnectedto
AT takigawamasateru whatarethepostablationinsularresidualelectrogramsintheposteriorleftpulmonaryveinselectricallyconnectedto
AT sasakitakehito whatarethepostablationinsularresidualelectrogramsintheposteriorleftpulmonaryveinselectricallyconnectedto
AT minamikentaro whatarethepostablationinsularresidualelectrogramsintheposteriorleftpulmonaryveinselectricallyconnectedto
AT naitoshigeto whatarethepostablationinsularresidualelectrogramsintheposteriorleftpulmonaryveinselectricallyconnectedto