Radiofrequency ablation in the left superior pulmonary vein can successfully eliminate ectopic pacemakers that mimic sinus rhythm in patients with paroxysmal atrial fibrillation.
Single-case ablation success in ectopic-driven paroxysmal AF warrants clinical caution; leaves open generalizability pending prospective validation.
We report the case of a patient with paroxysmal atrial fibrillation in whom the background cardiac rhythm falsely mimicked sinus rhythm but actually originated from the left superior pulmonary vein. P waves during the ectopic rhythm were flat in lead I, negative in lead aVL, and without a typical "dome-and-dart" feature in precordial leads. Radiofrequency applications inside the left superior pulmonary vein eliminated both atrial fibrillation and the ectopic pacemaker.
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Yamane et al. (2001) studied this question.
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