Key result
A case report demonstrated a premature depolarization concealed in two pulmonary veins, supporting the existence of myocardial tracts between pulmonary veins and a mismatch in activation ingress/egress.
Case Report (n=1)
This case report provides electrophysiological evidence supporting the existence of myocardial tracts extending into and between pulmonary veins, and a mismatch between pulmonary vein activation ingress and egress.
Does not alter ablation practice; leaves open whether inter-PV myocardial tracts affect AF recurrence or ablation success.
A case is presented in which a premature depolarization emanated from a partially activated left inferior pulmonary vein, activated the entire left superior pulmonary vein, but did not activate the atria ("concealed"). The site of conduction block between each vein and the left atrium was the anatomic atriovenous junction. At times, the same depolarization would activate the atria and initiate atrial fibrillation. The shortest depolarization coupling interval that activated the atria was significantly longer than the atrial fibrillation cycle length recorded in either vein. Observations in this case support two concepts: (1) the existence of myocardial "tracts," extending into and between pulmonary veins; and (2) a "mismatch" between pulmonary vein activation ingress and egress.
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David Schwartzman (2000) conducted a case report in Premature depolarization and atrial fibrillation (n=1). A case report demonstrated a premature depolarization concealed in two pulmonary veins, supporting the existence of myocardial tracts between pulmonary veins and a mismatch in activation ingress/egress.
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