Utility of entrainment pacing to clarify the circuit of macroreentrant tachycardia with dual early sites on activation maps Koichi Nagashima, MD, PhD,

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Date of download: 5/28/2016 Copyright © The American College of Cardiology. All rights reserved. From: Left atrial tachycardia after circumferential pulmonary.

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Utility of entrainment pacing to clarify the circuit of macroreentrant tachycardia with dual early sites on activation maps Koichi Nagashima, MD, PhD, Yasuo Okumura, MD, PhD, Ryuta Watanabe, MD, Masaru Arai, MD, Yuji Wakamatsu, MD, Ichiro Watanabe, MD, PhD HeartRhythm Case Reports Volume 4, Issue 2, Pages 66-69 (February 2018) DOI: 10.1016/j.hrcr.2017.11.006 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Electrocardiograms and 3-dimensional activation maps obtained in the case of atrial tachycardia (AT). A: Left atrial (LA) activation map of the AT. B: Entrainment pacing from the LA roof (pacing site 1, panel A). C: Entrainment from the other site of earliest activation in the left superior pulmonary vein (LSPV) (pacing site 2, panel A). D: The accurate activation map with the reannotation of the electrograms according to the tachycardia cycle length (TCL) and the results of entrainment pacing. The reentrant circuit is shown in red, yellow, green, and blue, and the bystander area is shown in pink. LA roof-dependent macroreentrant AT (black arrow) with a bystander LSPV region through the gap of the prior pulmonary vein isolation line (gray arrow) was diagnosed. ABL = ablation catheter; AP = anterior-posterior; CS = coronary sinus; LAA = left atrial appendage; LAT = local activation time; LIPV = left inferior pulmonary vein; MA = mitral annulus; PA = posterior-anterior; PV = pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein; TAT, total activation time. HeartRhythm Case Reports 2018 4, 66-69DOI: (10.1016/j.hrcr.2017.11.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 Electrocardiograms and 3-dimensional activation maps obtained in the case of ventricular tachycardia (VT). A: VT activation map of the right ventricle (RV) and left ventricle (LV). B: Entrainment pacing from the earliest activation site at the RV apex. C: Entrainment pacing from the other site of earliest activation at the LV apex opposite that of the RV apex. D: The accurate activation map with the reannotation of the electrograms according to the tachycardia cycle length (TCL) and the results of entrainment pacing. The reentrant circuit is shown in red, yellow, green, and blue, and the bystander area is shown in pink. Septal macroreentrant VT (solid white arrow) with a bystander area involving both ventricles (dotted white arrows) was diagnosed. ABL = ablation catheter; Ao = aorta; CS = coronary sinus; LAO = left anterior oblique; LAT = local activation time; PA = pulmonary artery; TA = tricuspid annulus; TAT = total activation time. HeartRhythm Case Reports 2018 4, 66-69DOI: (10.1016/j.hrcr.2017.11.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions