Multielectrode catheter was placed along the left superior
pulmonary vein, a quadripolar catheter in the HIS, a quadripolar catheter in the left atrial appendage (LAA), and a multielectrode catheter was inserted into the coronary sinus.
Other things to watch for are her heart rhythm, infection and further blockage in her
pulmonary veins.
Caption: Figure 2: CTA of the
pulmonary veins at anteroposterior (AP) view showing there is no left atrial appendage.
Two sequential applications are performed to create a box lesion by a continuous encircling line around the 4
pulmonary veins. Two times encircling box lesion set is the procedure ablation endpoint.
Contributing factors to diagnostic errors: Diagnostic error was most common with the mixed variety of TAPVR (seen in 80%) with three (75%) cases having only one
pulmonary vein draining separately while the other three
pulmonary veins drained within the confluence.
Spontaneous initiation of atrial fibrillation by ectopic beats originating in the
pulmonary veins. N Engl J Med 1998; 339: 659-66.
On echocardiography, there was no acceleration of blood flow at the left
pulmonary vein or surgical anastomosis between the pulmonary venous confluence and the atrium.
Lenz et al., "Catheter-based intervention for
pulmonary vein stenosis due to fibrosing mediastinitis: the Mayo Clinic experience," International journal of cardiology.
Shah et al., "Spontaneous initiation of atrial fibrillation by ectopic beats originating in the
pulmonary veins," New England Journal of Medicine, vol.
The standard of care in AF ablations is
pulmonary vein isolation (PVI)--the application of energy to create lines of scar tissue around the
pulmonary veins in the left atrium to block unwanted electrical signals that trigger AF.
Wilkoff also notes that high blood pressure and kidney disease can contribute to poor
pulmonary vein health, including the formation of blood clots in your
pulmonary veins.
Before the procedure, a 12 leads ECG recording, polysomnography, transthoracic and transesophageal echocardiography and computer-tomography (CT) of the
pulmonary veins were performed in all patients.