A new dissociated pulmonary vein activity (DPVA) was detected in a patient, according to a case report published in the Journal of Electrocardiology.

Clinicians at the Department of Cardiology and Cardiac Surgery at the Clinica Universidad de Navarra in Spain observed a unique DPVA pattern during radiofrequency catheter ablation using high density mapping.

The patient was a man aged 75 years who had paroxysmal atrial fibrillation.

Following successful pulmonary vein isolation, 2 simultaneous and independent ectopic rhythms were observed using a mini-basket (OrionÔ) device. The ectopic rhythms arose from opposite sides of the right superior pulmonary vein and were observed in poles B-E and F-H.


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DPVA may indicate successful pulmonary vein isolation, but may also be a sign of atrial fibrillation recurrence resulting from persistence of atrial sleeves in the venous wall. In the latter case, the rhythm is automatic, slow, and repetitive. The patient exhibited 2 dissociated ectopic rhythms in the presence of 2 independent sleeves in the right superior pulmonary vein, which was not conducted to the left atrium. An adenosine test did not indicate temporary reconnection.

A total of 3 DPVA patterns have previously been reported, including isolated ectopic beats, regular ectopic rhythm, and fibrillation. Observations made in the current patient may indicate the existence of a fourth type of dissociation pattern. Such a dissociated pattern may indicate the presence of independent myocardial sleeves in the pulmonary vein and highlight the importance of the pulmonary vein in pacing.

Reference

Albarrán-Rincón R, Ramos P, Shangutov O, et al. Dual-dissociated pulmonary vein activity after pulmonary vein isolation: What are its implications? J Electrocardiol. 2020;64:1-2. doi:10.1016/j.jelectrocard.2020.11.004