Atrial tachycardia originating from the pulmonary vein: importance of the stimulation sites.

The introduction of percutaneous ablative treatments for atrial fibrillation led to new information regarding the region of the left atrium and pulmonary veins, which electrophysiologists had previously overlooked. Initially, procedures for treating atrial fibrillation involved ablation and then the isolation of specific points in the pulmonary veins; this technique is still in use. Subsequent variations have included the use of multiple lines that are guided by electroanatomic mapping. All of these techniques have produced encouraging results, and the importance of stimulation sites in inducing various arrhythmias is known. Nevertheless, pacing maneuvers have rarely been used to evaluate electrophysiologic properties around the target areas.In a 53-year-old man who presented with a focal atrial tachycardia that originated from a pulmonary vein, we used different stimulation sites to induce arrhythmias in the region of the left atrium and pulmonary veins. The resultant unique arrhythmogenic values enabled successful ablation of the culprit pulmonary vein in this patient.