Key result
Catheter ablation with posterior wall isolation successfully maintained sinus rhythm without antiarrhythmic drugs for 12 months in a patient with a rare common inferior pulmonary vein variant.
Why the study?
The arrhythmogenicity of the common trunk in the rare common inferior pulmonary vein variant is unknown.
Case Report (n=1)
In patients with a common inferior pulmonary vein variant, substrate modification at the entrance of the common trunk may be necessary to prevent atrial fibrillation recurrence.
Hypothesis-generating for extra mapping of residual potentials at the CIPV–LA junction; leaves open whether this rare variant systematically predicts AF recurrence.
Background: The pulmonary vein (PV) variant is present in 23-38% of patients who undergo atrial fibrillation ablation, and the common inferior PV (CIPV) variant is a rare PV variant that has been reported in 0.9-1.5% of patients. The arrhythmogenicity of the common trunk of the CIPV is unknown. Case summary: A 77-year-old woman underwent catheter ablation for paroxysmal atrial fibrillation (AF). Preoperative computed tomography revealed a common trunk from which the bilateral inferior PVs and a left superior PV originated. The voltage map of the left atrium (LA) showed three PVs stemming from a common trunk. There was a low-voltage area bounded by the common trunk entrance. An isolation line was created to connect the right superior PV and the common trunk. Twelve months later, AF recurred. The voltage map in second session showed residual irregular potentials at the boundary between the common trunk and the LA, and posterior wall isolation was performed. Postoperatively, the patient maintained sinus rhythm with no antiarrhythmic drugs during the 12-month follow-up period. Discussion: The CIPV is likely to predict the AF recurrence, even if preoperative voltage mapping shows a low voltage area. Substrate modification should be performed on abnormal potentials at the entrance of the common trunk, even though no potential is detected in the PVs or their antrum.
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Kujiraoka et al. (2022) conducted a case report in Paroxysmal atrial fibrillation (n=1). Catheter ablation was evaluated on Maintenance of sinus rhythm. Catheter ablation with posterior wall isolation successfully maintained sinus rhythm without antiarrhythmic drugs for 12 months in a patient with a rare common inferior pulmonary vein variant.
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