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Updated: Jul 30, 2026

High-Resolution Endocardial and Epicardial Optical Mapping in a Sheep Model of Stretch-Induced Atrial Fibrillation
Published on: July 29, 2011
Block of the mitral-pulmonary isthmus during ablation of a single left-sided accessory pathway causing different
José Tarcísio Medeiros de Vasconcelos1, Eduardo Rodrigues Bento Costa, Silas dos Santos Galvão Filho
1Clínica de Ritmologia Cardíaca, Hospital Beneficência Portuguesa de São Paulo.
Abstract:
The case of a 16-year-old patient with atrioventricular tachycardia caused by a single left anterolateral accessory pathway is reported. When the patient underwent radiofrequency ablation, a lesion on the mitral annulus lateral wall produced changes in the retrograde atrial activation pattern determined by that pathway; changes ranged from a delay in depolarization of the annulus posterior portions to full left atrium counterclockwise activation. Such phenomena were probably caused by a block in the isthmus between the annulus and the lower left pulmonary vein ostium. This case illustrates the importance of the mitral-pulmonary isthmus in the process of left atrium activation, an alert to changes induced by its unintentional block during accessory pathway ablation.
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