Kujiraoka Hirofumi, Hojo Rintaro, Takahashi Masao, Fukamizu Seiji
Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan.
Eur Heart J Case Rep. 2022 Dec 17;7(1):ytac481. doi: 10.1093/ehjcr/ytac481. eCollection 2023 Jan.
The pulmonary vein (PV) variant is present in 23-38% of patients who undergo atrial fibrillation ablation, and the common inferior PV (CIPV) variant is a rare PV variant that has been reported in 0.9-1.5% of patients. The arrhythmogenicity of the common trunk of the CIPV is unknown.
A 77-year-old woman underwent catheter ablation for paroxysmal atrial fibrillation (AF). Preoperative computed tomography revealed a common trunk from which the bilateral inferior PVs and a left superior PV originated. The voltage map of the left atrium (LA) showed three PVs stemming from a common trunk. There was a low-voltage area bounded by the common trunk entrance. An isolation line was created to connect the right superior PV and the common trunk. Twelve months later, AF recurred. The voltage map in second session showed residual irregular potentials at the boundary between the common trunk and the LA, and posterior wall isolation was performed. Postoperatively, the patient maintained sinus rhythm with no antiarrhythmic drugs during the 12-month follow-up period.
The CIPV is likely to predict the AF recurrence, even if preoperative voltage mapping shows a low voltage area. Substrate modification should be performed on abnormal potentials at the entrance of the common trunk, even though no potential is detected in the PVs or their antrum.
肺静脉（PV）变异存在于23%至38%接受房颤消融的患者中，而常见下肺静脉（CIPV）变异是一种罕见的PV变异，在0.9%至1.5%的患者中被报道。CIPV共同干的致心律失常性尚不清楚。
一名77岁女性接受阵发性房颤（AF）导管消融术。术前计算机断层扫描显示一条共同干，双侧下肺静脉和一条左上肺静脉由此发出。左心房（LA）的电压图显示三条肺静脉起源于一条共同干。在共同干入口处有一个低电压区域。创建了一条隔离线连接右上肺静脉和共同干。十二个月后，房颤复发。第二次手术时的电压图显示共同干与左心房边界处有残余不规则电位，遂进行后壁隔离。术后，患者在12个月的随访期内未使用抗心律失常药物维持窦性心律。
即使术前电压标测显示有低电压区域，CIPV也可能预测房颤复发。即使在肺静脉或其窦部未检测到电位，也应对共同干入口处的异常电位进行基质改良。
