Key result
Ventricular pacing resolved rapid formation of spontaneous echo-contrast in the left atrium triggered by a vagally mediated pause during pulmonary vein antrum isolation.
Case Report (n=1)
Provides visual evidence that some AF patients with poor atrial transport function depend on ventricular emptying, highlighting potential thromboembolic risk during long ventricular pauses.
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Highlights potential role of ventricular pacing to avert left atrial stasis during ablation pauses; leaves open clinical adoption pending further evidence.
We report a case of a patient with long-standing persistent atrial fibrillation (AF) who had rapid formation of spontaneous echo-contrast in the left atrium during pulmonary vein antrum isolation set off by a vagally mediated pause despite standard anticoagulation protocol. Spontaneous echo contrast resolved with ventricular pacing, representing visual evidence for dependence of some AF patients with poor atrial transport function on ventricular emptying with potential greater risk of thromboembolism related to a long ventricular pause.
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Khaykin et al. (2011) conducted a case report in Long-standing persistent atrial fibrillation (n=1). Ventricular pacing was evaluated on Resolution of spontaneous echo-contrast. Ventricular pacing resolved rapid formation of spontaneous echo-contrast in the left atrium triggered by a vagally mediated pause during pulmonary vein antrum isolation.
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