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Notched P-wave related to a conduction disturbance in a thoracic vein as a potential arrhythmogenic substrate of atrial fibrillation
  • +3
  • Noriyuki Kobayashi,
  • Teppei Yamamoto,
  • Yuhi Fujimoto,
  • Kenji Yodogawa,
  • Yu-ki Iwasaki,
  • Wataru Shimizu
Noriyuki Kobayashi
Nippon Medical School
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Teppei Yamamoto
Nippon Medical School
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Yuhi Fujimoto
Nippon Medical School
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Kenji Yodogawa
Nippon Medical School
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Yu-ki Iwasaki
Nippon Medical School
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Wataru Shimizu
Nippon Medical School
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Abstract

A 65-year-old male underwent a second ablation procedure for recurrent paroxysmal atrial fibrillation (AF). Twelve-lead ECG during sinus rhythm exhibited biphasic and split P-wave with a prolonged duration, which called notched P-wave (NPW). Radio-frequency applica-tion in the coronary sinus (CS) resulted AF termination and elimination of triggering ectopy with NPW disappearance. The CS musculature which played a principal role in triggering and maintaining AF formed the NPW. In patients with repetitive recurrent AF after the estab-lishment of the PV isolation who exhibit NPW during sinus rhythm, the CS might be one of the arrhythmogenic sources of AF.