A completely occluded pulmonary vein stump can still exhibit triggered firing and initiate atrial fibrillation, necessitating its isolation during ablation.
PV stump mapping remains feasible post-radiation occlusion; leaves open whether pre-ablation imaging protocols improve safety.
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 andB) 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...
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Leyton‐Mange et al. (2021) studied this question.
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