A Distinctive Strategy for Catheter Ablation in Patients With Bilateral Common Ostium in the Inferior Pulmonary Veins: A Case Report

Abstract

Pulmonary vein anatomical variations are frequently observed in atrial fibrillation patients undergoing catheter ablation. However, when it comes to patients with atrial fibrillation and bilateral common ostium in the inferior pulmonary veins, using a bilateral circumferential pulmonary vein isolation approach during catheter ablation heightens the risk of esophageal injury. At present, there is no established standard catheter ablation strategy for such cases. A 47-year-old female with atrial fibrillation underwent catheter ablation. Prior to the procedure, a left atrial computed tomography angiography indicated a common ostium of the left and right inferior pulmonary veins. During mapping, a low-voltage area was found in the patient's left atrial posterior wall. To avoid esophageal injury and effectively isolate both pulmonary veins and the low-voltage area with minimal ablation points, we used a single-ring ablation approach. In a 12 month follow-up, the patient had no atrial fibrillation recurrence.