Ensuring Durable Pulmonary Vein Isolation

A 55 year old man with paroxysmal atrial fibrillation (AF) was referred for catheter ablation because of symptomatic recurrent episodes (2-3 episodes per month lasting between 2-6 hours) despite multiple antiarrhythmic drugs trials (including amiodarone).

Figure 1: Ensuring Durable Pulmonary Vein Isolation

Figure 2: Ensuring Durable Pulmonary Vein Isolation

No hypertension, diabetes or coronary heart disease. Normal echocardiogram.

Magnetic resonance imaging (MRI) demonstrated normal pulmonary vein anatomy with 4 distinct pulmonary vein ostia.

Pulmonary vein isolation (PVI) was performed using an irrigated-tip radiofrequency ablation catheter guided by a circular mapping catheter. A three-dimensional, nonfluoroscopic mapping system (NavX system) was used for the procedure (Figure 1).

Spontaneous initiation of AF from the left superior pulmonary vein (LSPV) was observed during the case.

The endpoint of electrical pulmonary vein isolation (entrance and exit block) was confirmed in each of the 4 PVs after an observation time of 30 minutes post ablation (Figure 2).

At that point in the ablation procedure, the next step that may help to ensure durable PV isolation and avoid PV reconnection would be:

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