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Presentation transcript:

Lilian Mantziari et al. JACEP 2015;1:411-420 Linear Lesions (A) Focused map of the LA roof seen from above (superior view of the roof) during pacing from the LAA (the LAA is not shown on this map). The local EGM at the site of the gap is 39 ms earlier to the reference (CS 7-8). (B) Additional ablation on the site (A) resulted in roof line blockage. (B) Activation and voltage maps of the LA roof are shown with double potential on the roof line. (C) Focused map of the mitral isthmus area after a mitral isthmus line was deployed. Activation map is shown during pacing from the LAA (case 13). A breakthrough of activation is seen in the middle of the mitral isthmus line with the corresponding fractionated local EGM. The voltage map below shows an isthmus of very low voltage on the mitral line. The voltage on the gap is 0.068 mV. (D) Re-map of the mitral isthmus area in LAA pacing after further ablation shows no endocardial conduction in the mitral isthmus and scarring along the line. However, there is still epicardial conduction over the CS. Further ablation inside the CS resulted in MVI block. CS = coronary sinus; EGM = electrogram; LA = left atrium; LAA = left atrial appendage; LLPV = left lower pulmonary vein; LUPV = left upper pulmonary vein; MV = mitral valve; MVI = mitral valve isthmus; RUPV = right upper pulmonary vein. Lilian Mantziari et al. JACEP 2015;1:411-420 American College of Cardiology Foundation