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.