Maintenance of Atrial Fibrillation by Pulmonary Vein Tachycardia with Ostial Conduction Block: Evidence of an Interpulmonary Vein Electrical Connection


  • Sébastien Knecht is supported by the Belgian “Funds for Cardiac Surgery.”

  • Manuscript received 4 December 2007; Revised manuscript received 27 January 2008; Accepted for publication 1 February 2008.

Address for correspondence: Seiichiro Matsuo, M.D., Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France. Fax: +33-55-765-6509; E-mail:


We report a case of a 56-year-old man with paroxysmal atrial fibrillation who underwent segmental, ostial pulmonary vein (PV) isolation while in arrhythmia. During isolation of the left superior PV (LSPV), organized electrical activity was seen within the vein, suggestive of a PV tachycardia with a cycle length of 90 ms. Simultaneously, organized electrical activity with a cycle length of 180 ms was seen in the left inferior PV (LIPV), suggestive of 2:1 conduction between the LSPV and the LIPV. Isolation of the LIPV resulted in conversion to sinus rhythm, while confirming isolation of the LSPV by the presence of ongoing PV tachycardia in this vein. This case demonstrates a direct electrical connection between the ipsilateral left PVs, leading to maintenance of atrial fibrillation.