Commentaries:
It has been recognized that dissociated pulmonary vein activity (DPVA) is a signal of successful pulmonary vein isolation (PVI). Nevertheless, there are concerns about the possibility of AF recurrence in presence of these DPVA because of the persistence of atrial sleeves in the venous wall with automatic, slow, and less commonly, rapid and repetitive rhythm 1,2. In Figure 1 there are two dissociated ectopic rhythms that demonstrated the presence of independent sleeves in the RSPV that were not conducted to the left atrium, proving exit-block. Perhaps it has been reported that DPVA may be one of the risk factor of AF recurrence 3,4, however, pacing from the PV could confirm lack of conduction to LA5. In this regard, Figure 2 and Figure 3 show that the dual-dissociated activity was further confirmed by pacing, achieving local electrogram capture independently.
There have been reported three DPVA patterns: (1) isolated ectopic beats; (2) regular ectopic rhythm; and (3) fibrillation6. To the best of our knowledge, this is the first report showing a new dissociation pattern demonstrating electrophysiologically the potential presence of independent myocardial sleeves into the PV, pointing out the importance of pacing around the whole vein regardless the presence of DPVA.