Common left pulmonary vein: a consistent source of arrhythmogenic atrial ectopy

The discovery of a consistent relationship between atrial anatomy and electrophysiology would have practical value and may provide insight into arrhythmia mechanism. We previously observed that anatomically common left pulmonary veins were a disproportionate source of atrial ectopy that was associated with the initiation of atrial fibrillation ("arrhythmogenic"). This report details our efforts to characterize and quantify this observation.

One hundred subjects with paroxysmal atrial fibrillation underwent computed tomographic scanning to characterize left atrial anatomy and invasive electrophysiology study to characterize events associated with the initiation of atrial fibrillation. Some of these subjects also underwent radiofrequency catheter ablation. The left pulmonary vein was common in 14 subjects and was a consistent source of arrhythmogenic ectopy. This relationship was significantly stronger than for any other individual vein or ipsilateral vein combination. Myocardium located within the common vein trunk was the site of origin of the ectopy in most subjects. This myocardium did not have unique electrophysiologic properties. Catheter ablation to isolate myocardium proximal to junction between the common vein and the left atrial body cured all patients in whom the vein was the sole source of arrhythmogenic ectopy.

In this cohort, a common left pulmonary vein was a consistent source of arrhythmogenic atrial ectopy.