Rate-dependent and unidirectional conduction block between the left pulmonary vein and left atrium after catheter ablation for atrial fibrillation.

A 77-year-old woman with symptomatic paroxysmal atrial fibrillation (PAF) underwent pulmonary vein isolation (PVI), but subsequently experienced recurrence. In the second session, unidirectional left atrium (LA)-left superior pulmonary vein (LSPV) conduction was revealed to exist at the carina of the LSPV. Left pulmonary vein (LPV) pacing performed in a cycle between 300 and 260 ms revealed rate-dependent pulmonary vein (PV)-LA conduction, and the location was estimated to be in the roof of the LSPV. PV isolation was achieved after ablation of two gaps. Consideration of the presence of rate-dependent gaps may be useful to confirm bidirectional block lines after ablation.