Fujiwara Masaki, Takemoto Masao, Koga Tokushi, Tsuchihashi Takuya
Cardiovascular Center, Steel Memorial Yawata Hospital, 1-1-1 Haruno-machi, Yahatahigashi-ku, Kitakyushu 805-8508, Japan.
Eur Heart J Case Rep. 2023 Mar 27;7(4):ytad135. doi: 10.1093/ehjcr/ytad135. eCollection 2023 Apr.
Recent reports have demonstrated that ∼10% of patients with atrial fibrillation (AF) have epicardial connections (ECs) inside the pulmonary vein (PV) antrum isolation (AI) (PVAI) lines, which could be a possible mechanism of failure to achieve a complete PVAI, thus contributing to AF recurrence.
We present an 80-year-old female case with consistently continuing AF associated with ECs. Epicardial connections involving the PVs were detected in the left and right superior PVs after the completion of the PVAI. The AF steadily terminated after the ablation of those ECs. She has remained well without any AF or symptoms for 2 years post-ablation.
Those ECs might have played a possible important role in initiating and maintaining the AF. The mechanism(s) of the ECs may be a cornerstone of the failure to achieve a complete PVAI contributing to AF recurrence. Ablation of the EC(s) in addition to the PVAI may be better able to achieve the completion of the PVAI. Thus, physicians should be aware of the possibility of the presence of EC(s) when performing ablation of AF, even though complete PVAI lines have been achieved.
最近的报告表明，约10%的心房颤动（AF）患者在肺静脉（PV）前庭隔离（AI）（PVAI）线内存在心外膜连接（ECs），这可能是未能实现完全PVAI的一种潜在机制，进而导致AF复发。
我们报告一例80岁女性持续性AF合并ECs的病例。在完成PVAI后，在左、右上PVs中检测到涉及PVs的心外膜连接。消融这些ECs后，AF稳定终止。消融术后2年，她一直状况良好，未出现任何AF或症状。
这些ECs可能在AF的启动和维持中发挥了重要作用。ECs的机制可能是导致未能实现完全PVAI并促成AF复发的关键因素。除PVAI外，消融ECs可能更有助于实现完全PVAI。因此，即使已实现完整的PVAI线，医生在进行AF消融时也应意识到存在ECs的可能性。
