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A case of concealed inferior vena cava bigeminy in a patient of atrial fibrillation
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  • Ryutaro Sakurai,
  • Seigo Yamashita,
  • Hirotsuna Oseto,
  • Kenichi Tokutake,
  • Michihiro Yoshimura,
  • Teiichi Yamane
Ryutaro Sakurai
Jikei University School of Medicine
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Seigo Yamashita
Jikei University School of Medicine

Corresponding Author:seigoy722@yahoo.co.jp

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Hirotsuna Oseto
Jikei University School of Medicine
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Kenichi Tokutake
Jikei University School of Medicine
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Michihiro Yoshimura
Jikei University School of Medicine
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Teiichi Yamane
Jikei University School of Medicine
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Abstract

We report a case of atrial fibrillation with frequent monomorphic atrial premature contractions (APCs) in which P-wave morphology was negative in II, III, and aVF and positive in I and aVL leads. After pulmonary vein isolation using a cryoballoon, high-resolution electroanatomical mapping revealed ectopic beats from the posteroseptal area within the inferior vena cava (IVC) with concealed bigeminy. Catheter ablation just above the ectopic focus eliminated the APC with residual dissociated activity inside the IVC. This is the first report to reveal continuous ectopic bigeminy definitely originating from the tiny area within the IVC by detailed three-dimensional mapping.