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(Circulation. 2002;105:2821.)
© 2002 American Heart Association, Inc.

Brief Rapid Communications

Left Atrial Appendage Activity Masquerading as Pulmonary Vein Potentials

Dipen Shah, MD; Michel Haissaguerre, MD; Pierre Jais, MD; Meleze Hocini, MD; Teiichi Yamane, MD; Laurent Macle, MD; Kee Joon Choi, MD; Jacques Clementy, MD

From the Division of Cardiology (D.S.), University Hospital, Geneva, Switzerland; and Service de Electrophysiologie (M. Haissaguerre, P.J., M. Hocini, T.Y., L.M., K.J.C., J.C.), Hopital Cardiologique du Haut-Leveque, Pessac Cedex, France.

Correspondence to Dr Dipen Shah, Div of Cardiology, University Hospital, 24, Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. E-mail Dipen.Shah{at}hcuge.ch

Background— Despite extensive proximal ablation, all potentials frequently cannot be eliminated from the left pulmonary veins (PV).

Methods and Results— PV electrograms were analyzed during sinus rhythm, coronary sinus, and left atrial appendage (LAA) pacing, and PV and LAA angiography performed. During pacing, an initial low-amplitude slow potential was recorded on the anterior aspect of the left superior PV and anticipated with shortest activation time by LAA pacing. Its timing coincided with posterior LAA activation, shown to be immediately adjacent to the left superior PV by angiography. In the left inferior PV, the first potential was smaller and less sharp, coinciding with adjacent low LA activation. Angiographically, the LAA was at least 15 mm from the left inferior PV. The second sharper potential in both left PVs was eliminated by proximal ablation.

Conclusion— Far field LAA activity consistently adds to PV myocardial electrograms in the left superior PV whereas lower, less sharp extravenous potentials in the left inferior PV originate from the inferior LA. They can be identified by LAA and coronary sinus pacing.

Key Words: ablation • fibrillation • pulmonary veins

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