(FIT)-Module 3 Workshop 5: Invasive and Non-Invasive Correlation-Marchlinski Case 2 Question

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Video Summary

Okay, here's our next case. Following a successful pulmonary vein isolation, the patient demonstrates recurrent AFib in response to isopreterinol. All veins remain isolated. The P wave of the first atrial complex triggering atrial fibrillation is shown in tracing 12-1. The intracardiac activation in tracing 12-2 of the same trigger is demonstrated on multipolar catheters located as shown on fluoroscopy in the proximal coronary sinus and the extending along the right atrium up into the SVC. What is the most likely origin of the non-PV trigger based on the information provided and your choices are A, superior vena cava, B, infralateral coronary sinus, C, superior LA posterior wall, and D, Eustachian ridge. Here are the tracings, again, tracing 12-1 showing the trigger on the 12-lead ECG morphology of that initiating beat, tracing 12-2, the intracardiac recordings from the coronary sinus, and a multipolar catheter in the right atrium extending, as you can see, up into the SVC, and the coronary sinus catheter is placed proximally as described, and the origin of the non-pulmonary vein AF trigger based on these recordings from the choices shown. Okay, take your time, review the tracings and your choices and provide the correct answer.

Keywords

pulmonary vein isolation

atrial fibrillation

non-PV trigger

superior vena cava

intracardiac activation