Published Online
on May 28, 2002

A more recent version of this article appeared on June 18, 2002

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Submitted on February 21, 2002
Revised on April 26, 2002
Accepted on April 28, 2002

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, and 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.

^* To whom correspondence should be addressed. 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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