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Case Reports
. 2020 Nov 18;2(14):2244-2248.
doi: 10.1016/j.jaccas.2020.09.048.

Atrial Fibrillation Triggered by Premature Ventricular Complexes: An Under-Recognized Trigger

Matthew Bocchese  1 , Hardik Mangrolia  2 , Anuj Basil  2 , Chethan Gangireddy  2 , Edmond Cronin  2 , George A Yesenosky  2 , Richard M Greenberg  2 , Joshua M Cooper  2 , Isaac R Whitman  2
Affiliations
Case Reports

Atrial Fibrillation Triggered by Premature Ventricular Complexes: An Under-Recognized Trigger

Matthew Bocchese et al. JACC Case Rep. .

Abstract

Atrial fibrillation (AF) is a triggered rhythm, and ablation of the trigger is a common strategy for rhythm control. We describe a patient with symptomatic AF who was found to have episodes of AF triggered by premature ventricular complexes, likely by retrograde atrioventricular nodal conduction. (Level of Difficulty: Beginner.).

Keywords: AF, atrial fibrillation; AP, accessory pathway; PAC, premature atrial complex; PVC, premature ventricular complex; PVI, pulmonary vein isolation; ablation; atrial fibrillation; electrophysiology; palpitations.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Premature Ventricular Complex Initiating Atrial Fibrillation Premature ventricular complexes initiating atrial fibrillation are denoted by the red arrow. Preceding sinus beats with P-waves are denoted by blue arrows.
Figure 2
Figure 2
Frequent Left Bundle, Inferior Axis Premature Ventricular Complexes (A) Frequent left bundle, inferior axis premature ventricular complexes noted during the patient’s ablation procedure. (B) Representative premature ventricular complex with retrograde conduction with a VA interval of 161 ms. Baseline PR interval of 176 ms.
Figure 3
Figure 3
Strips of Overnight Telemetry Monitoring Showing Salvos of Self-Limited Atrial Fibrillation (A) Strips of overnight telemetry monitoring showed salvos of self-limited atrial fibrillation initiated by premature ventricular complexes denoted by the red arrows. (B) Post-procedural ambulatory rhythm monitor showed episodes of atrial fibrillation initiated by a premature ventricular complex denoted by the red arrow.
See this image and copyright information in PMC

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