A case of concealed inferior vena cava bigeminy in a patient of atrial
fibrillation
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.