Author + information
- Joseph Gard, MD and
- Sam Asirvatham, MD⁎ ()
- ↵⁎Division of Cardiovascular Diseases Department of Pediatrics and Adolescent Medicine/Division of Pediatric Cardiology Mayo Clinic 200 First Street SW, Mary Brigh 4-523, Rochester, Minnesota 55905
We thank Dr. Nessel for his comment regarding our observations (1). We were unaware of this interesting paper describing the distribution of blood flow in the isolated lung (2). This is certainly an intriguing possible explanation as to why different degrees of fibrosis may occur around specific pulmonary veins. We should emphasize that the reasons for conduction delay at the pulmonary vein ostia and for spatial specificity for fibrotic changes are unknown at the present time. In an interventional electrophysiology practice, the left inferior pulmonary vein (3,4) typically shows more significant delay between the left atrial signal and the pulmonary vein potential than the right inferior pulmonary vein. Further, of the pulmonary veins, the right inferior vein may be the least likely to serve as a trigger for atrial fibrillation and have qualitatively different pulmonary vein electrograms. The right inferior vein is also the most posterior of the pulmonary veins because of the anterior crossing and course of the right lower pulmonary artery. The correlations, if any, among venous flow dynamics, local fibrosis, and arrhythmogenicity of a given pulmonary vein require exploration, and we thank Dr. Nessel for bringing this observation to our attention.
- American College of Cardiology Foundation