Left-Sided Pulmonary Isolations After Complete Right-Sided Pneumonectomy: Technical Challenges to Clinical Success
Keywords:Atrial fibrillation, Pneumonectomy, Ablation, Pulmonary vein stumps
Male patient, 76 years old, presented symptomatic paroxysmal AF for almost 2 years. Long submitted to total right pneumonectomy and having a major cardiac rotation. The use of tomography and intracardiac ultrasound were fundamental for a better anatomic comprehension and optimization of the safety procedures for AF ablation in these patients, due to the difficulty in accessing the left atrium and the consequent manipulation of catheters. In this case, electrical signals have not yet been detected in the stumps on the right side, with only the left veins being isolated. This approach constitutes a new approach in this clinical situation, with clinical success in a 3-year follow-up.
Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Metayer P, and Clementy J, Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med, 1998. 339(10): p. 659-66.
Calkins H, Hindricks G, Cappato R, Kim Y, Saad EB, Aguinaga L, et al. 2017 HRS / EHRA / ECAS / APHRS / SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275-444.
Konstantinidou M, Schmidt B, Ouyang F, Koektuerk B, Kuck KH, and Chun KR, Pulmonary vein isolation after left-sided pneumonectomy: technically challenging but feasible and instructive. Europace, 2009. 11(3): p. 389-91.
Smulders SA, Holverda S, Vonk-Noordegraaf A, van den Bosch HC, Post JC, Marcus JT, Smeenk FW, and Postmus PE, Cardiac function and position more than 5 years after pneumonectomy. Ann Thorac Surg, 2007. 83(6): p. 1986-92.
Krowka MJ, Pairolero PC, Trastek VF, et al. Cardiac dysrhythmia following pneumonectomy. Clinical correlates and prognostic significance. Chest. 1987; 91(4): 490–495.
Smulders SA, Holverda S, Vonk-Noordegraaf A, et al. Cardiac function and position more than 5 years after pneumonectomy. Ann Thorac Surg. 2007; 83(6): 1986–1992. 7. Konstantinidou M, Schmidt B, Ouyang F, et al. Pulmonary vein isolation after left- sided pneumonectomy: technically challenging but feasible and instructive. Europace. 2009; 11(3): 389–391.
Dixit S, Sauer WH, Callans DJ, Marchlinski FE. Arrhythmogenic potential of pulmonary venous tissue: triggers for atrial fibrillation identified within the remnant of a vein. J Cardiovasc Electrophysiol 2009;20:441–4.
Kanmanthareddy A, Vallakati A, Reddy M, Dixit S, Di Biase L, Mansour M et al. Pulmonary Vein Isolation for Atrial Fibrillation in the Post-Pneumonectomy Population: A Feasibility, Safety and Outcomes Study. J Cardiovasc Electrophysiol. 2015 Apr;26(4):385-389