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Case report of persistent atrial fibrillation with durably isolated pulmonary veins: what's next?
Bengel, Philipp; Sossalla, Samuel; Dinov, Borislav.
Affiliation
  • Bengel P; Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, Klinikstr. 33, 35392 Giessen, Germany.
  • Sossalla S; Department of Internal Medicine I, Cardiology and Angiology, Justus-Liebig-University Giessen, Klinikstr. 33, 35392 Giessen, Germany.
  • Dinov B; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
Eur Heart J Case Rep ; 8(8): ytae358, 2024 Aug.
Article in En | MEDLINE | ID: mdl-39104517
ABSTRACT

Background:

Pulmonary vein isolation (PVI) has emerged as a safe and effective treatment for patients with paroxysmal and persistent atrial fibrillation. Nevertheless, in some patients, a relapse of atrial fibrillation occurs although pulmonary veins are durably isolated. For those patients, the underlying mechanisms of atrial fibrillation perpetuation are manifold and optimal treatment options are not yet defined. Case

summary:

We describe a case of a 55-year-old man with a history of atrial fibrillation and previous PVI presenting with persistent AF and arrhythmia induced cardiomyopathy. During the redo procedure, electro-anatomical mapping revealed durably isolated PV. Bipolar mapping showed large low-voltage areas at the posterior wall and the septum. As the patient was refractory to electrical cardioversion, it was decided to modify the large low-voltage areas as potential arrhythmic substrate. After performing additional ablation with isolation of the posterior wall and two anterior/septal lines, the patient spontaneously converted to sinus rhythm.

Discussion:

Ablation in patients with persistent AF despite durable PVI remains a challenge for the treating team. Individualized ablation approaches addressing additional arrhythmic substrates or extra-PV triggers can be considered to treat patients with persistent AF and durable PVI.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Eur Heart J Case Rep Year: 2024 Document type: Article Affiliation country:

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Eur Heart J Case Rep Year: 2024 Document type: Article Affiliation country: