Highlights the potential for epicardial connections to maintain unidirectional conduction between the left atrium and pulmonary vein after complete endocardial ablation.
Should not yet change PVI technique based on one case; leaves open incidence of left-sided epicardial PV-LA connections.
The presence of an epicardial connection between the left-sided pulmonary vein and left atrium was suggested during catheter ablation of atrial fibrillation because of sustainable unidirectional entrance conduction after complete endocardial ablation, centrifugal breakout deep inside the pulmonary vein, and immediate elimination of the conduction by point ablation. (Level of Difficulty: Advanced.)
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Niiyama et al. (2022) studied this question.
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