\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[english]{babel}



\usepackage{float}








\begin{document}

\title{Beating pulmonary vein sign during catheter ablation}



\author[1]{Shinichi Ishida}%
\author[1]{Yoshio Takemoto}%
\author[1]{Yuichiro Yamase}%
\author[1]{Kei Yagami}%
\affil[1]{Gifu Prefectural Tajimi Hospital}%


\vspace{-1em}



  
  \date{May 26, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
The beating of a pulmonary vein during cardiac catheterization is a rare
phenomenon caused by the heart beating through the pericardial effusion
when a cardiac tamponade occurs. This ``beating pulmonary vein'' sign is
useful for early detection of a tamponade before circulatory collapse
occurs.%
\end{abstract}%



\sloppy


Title: Beating pulmonary vein sign during catheter ablation

Authors:

Shinichi Ishida MD\textsuperscript{1}, Yoshio Takemoto
MD-PhD\textsuperscript{2}, Yuichiro Yamase MD\textsuperscript{2}, Kei
Yagami MD-PhD\textsuperscript{1}

\textsuperscript{1}Department of Cardiac Surgery, Gifu Prefectural
Tajimi Hospital, Tajimi, Gifu, Japan

\textsuperscript{2}Department of Cardiovascular Medicine, Gifu
Prefectural Tajimi Hospital, Tajimi, Gifu, Japan

Conflicts of interest: The authors declare that there are no conflicts
of interests.

Financial disclosures: The authors received no financial support for the
preparation of this article.

Acknowledgment: No relevant acknowledgments.

Corresponding Author: Shinichi Ishida, 5-161 Maebata-cho, Tajimi-city,
Gifu 507-8522, Japan, +81-572-22-5311, e-mail:shin1dinho@yahoo.co.jp

Key clinical message:

The ``beating pulmonary vein'' sign during cardiac catheterization is
useful for early detection of a tamponade before circulatory collapse
occurs. Moreover, we need to be careful when finding the beating of
venous system that does not usually beat.

Abstract:

The beating of a pulmonary vein during cardiac catheterization is a rare
phenomenon caused by the heart beating through the pericardial effusion
when a cardiac tamponade occurs. This ``beating pulmonary vein'' sign is
useful for early detection of a tamponade before circulatory collapse
occurs.

Key words: Cardiac tamponade, Cardiac catheterization, Beating pulmonary
vein

Clinical presentation:

A 71-year-old man with a history of paroxysmal atrial fibrillation
underwent cryoballoon catheter ablation. Immediately after undergoing
left superior pulmonary vein (LSPV) ablation, his blood pressure
decreased to 45/35 mmHg. Thoracic echocardiography revealed a tamponade,
which was immediately treated with drainage by needle paracentesis. The
patient's hemodynamic state stabilized after pericardial blood drainage
with inotropic drug support and blood transfusion. The laceration site
was assumed to be at the left atrium roof close to the LSPV during
transatrial puncture with the cryoballoon sheath.

The angiography recorded while the LSPV was occluded using a cryoballoon
showed the LSPV to be already beating before a decline in blood pressure
(Figure 1, Video 1), which was identified retrospectively. This
phenomenon was presumably caused by the heart beating through the
pericardial effusion. This ``beating PV'' sign is useful for early
detection of a tamponade before circulatory collapse occurs.

Figure caption:

Figure 1. Angiogram showing synchronized beating of the left superior
pulmonary vein (arrow) and heart. A, Systole. B, Diastole.

Video 1. Angiography performed during ablation of the left superior
pulmonary vein. The beating of the left superior pulmonary vein is
synchronized with the heartbeat.

Ethical statement:

Institutional review board approval was exempted at our institution for
this retrospectively designed report and no informed consent is
applicable given that no identifying information was used.

Author contributions:

SI: wrote the draft of the manuscript and prepared the figures. SI, HT
and YY: involved in writing. SI, HT and KY: revised and approved the
final manuscript.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1/Figure-1}

\end{center}
\end{figure}

\selectlanguage{english}
\FloatBarrier
\end{document}

