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J Thorac Cardiovasc Surg 2003;126:914-916
© 2003 The American Association for Thoracic Surgery

Brief communications

Origin of atrial fibrillation from the pulmonary veins in a mitral patient

Joao Q. Melo, MD, PhDa,*, Stefano Benussi, MD, PhDa, Walter Tortoriello, MDa, Vicenzo Santinelli, MDa, Simone Calvi, MDa, Simona Nascimbene, MDa, Carlo Pappone, MDa, Ottavio Alfieri, MDa

a Divisions of Cardiac Surgery and Cardiology, Ospedale San Raffaele, Milan, Italy

Received for publication December 13, 2002; accepted for publication December 27, 2002.

* Address for reprints: João Melo, Hospital Santa Cruz, Av. Prof. Dr. Reinaldo Dos Santos 27, 2790—136 Carnaxide, Portugal
joaomelo100@hotmail.com

The first 20% of the full text of this article appears below.

In mitral patients the origin and mechanisms of atrial fibrillation are largely unknown. Even though several theories have been postulated for its origin, there is scarce evidence to support them. Surgical procedures that electrically isolate the pulmonary veins from the left atrial chamber are associated with a very high success rate. We report a case of a mitral patient with permanent atrial fibrillation who underwent mitral valve replacement and extended bilateral isolation of the pulmonary veins using intraoperative radiofrequency ablation. After surgery, bidirectional electrical block from the right pulmonary veins was documented.

Postoperative epicardial recordings and Holter monitoring showed paroxysmal tachycardia limited to the atrial cuff of the right pulmonary veins while the patient remained in stable sinus rhythm.

Clinical summary

This 56-year-old female patient had severe mitral valve stenosis with moderate regurgitation, tricuspid regurgitation, and permanent atrial fibrillation of 10 months’ duration. She was in New York Heart Association class functional II, with a peak systolic pulmonary artery pressure of 50 . . . [Full Text of this Article]






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