Single-shot antral isolation of a common pulmonary vein by the hot balloon Yuji Wakamatsu, MD, Koichi Nagashima, MD, PhD, Ryuta Watanabe, MD, Masaru Arai,

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Single-shot antral isolation of a common pulmonary vein by the hot balloon Yuji Wakamatsu, MD, Koichi Nagashima, MD, PhD, Ryuta Watanabe, MD, Masaru Arai, MD, Naoto Otsuka, MD, Yasuo Okumura, MD, PhD HeartRhythm Case Reports Volume 5, Issue 3, Pages 176-178 (March 2019) DOI: 10.1016/j.hrcr.2018.12.008 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 Three-dimensional reconstructed left atrial image (A), left atriography (B), antral occlusion of the common trunk of the left pulmonary veins by the hot balloon (C), and voltage map after an antral isolation of a left common pulmonary vein (D). On the voltage map, the purple areas are high-voltage zones with a bipolar electrogram amplitude of ≥0.5 mV. The red, orange, yellow, green, and blue areas are low-voltage zones of <0.5 mV, ie, ablation lesions. HB = hot balloon; LA = left atrium; LCPV = left common pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein. HeartRhythm Case Reports 2019 5, 176-178DOI: (10.1016/j.hrcr.2018.12.008) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 Three-dimensional reconstructed left atrial image and fluoro images of the antral occlusion of the common trunk of the pulmonary veins by the hot balloon (HB) in cases 2 (A, B), 3 (C, D), 4 (E, F), and 5 (G, H). In case 2, the left common pulmonary vein (LCPV) ostium was 33 × 26 mm in diameter and 640 mm2 in area, which was isolated by the HB inflated with a fluid injection of 16 mL. In case 3, the LCPV ostium was 38 × 20 mm in diameter and 360 mm2 in area, which was isolated by the HB inflated with a fluid injection of 16 mL. In case 4, the LCPV ostium was 32 × 23 mm in diameter and 560 mm2 in area, which was isolated by the HB inflated with a fluid injection of 12 mL. In case 5, the right common pulmonary vein ostium was 25 × 17 mm in diameter and 360 mm2 in area, which was isolated by the HB inflated with a fluid injection of 19 mL. HeartRhythm Case Reports 2019 5, 176-178DOI: (10.1016/j.hrcr.2018.12.008) Copyright © 2018 Heart Rhythm Society Terms and Conditions