Catheter ablation for the treatment of persistent atrial fibrillation: Maintenance of sinus rhythm with left atrial appendage and coronary sinus isolation.

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Presentation transcript:

Catheter ablation for the treatment of persistent atrial fibrillation: Maintenance of sinus rhythm with left atrial appendage and coronary sinus isolation after multiple ablation procedures Dong Po Liang, MD, Tina Lin, MBBS, BMedSci, FRACP, Roland Tilz, MD, Andreas Metzner, MD, Karl-Heinz Kuck, MD, FHRS, Feifan Ouyang, MD HeartRhythm Case Reports Volume 2, Issue 2, Pages 113-118 (March 2016) DOI: 10.1016/j.hrcr.2015.05.003 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Left atrial appendage (LAA) activity. A: Electrogram recordings demonstrating rapid firing within the LAA, as seen by the lasso signals. B: Pacing from within the LAA leads to termination of atrial fibrillation. HeartRhythm Case Reports 2016 2, 113-118DOI: (10.1016/j.hrcr.2015.05.003) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Left atrial appendage (LAA) isolation. A: Ablation at the posterior mitral isthmus leads to isolation of the LAA. B: Intracardiac electrograms showing LAA isolation. The lasso is placed in the LAA, with 1:1 conduction during the first 3 beats, then no further signal on the spiral catheter during sinus rhythm (entrance block). Red tags = ablation points; white tags = pulmonary vein ostia; pink tags = fractionated potentials; yellow tag = point of isolation of the LAA; AP = anterior-posterior; PA = posterior-anterior; RA = right atrium; LA = left atrium; CS = coronary sinus. HeartRhythm Case Reports 2016 2, 113-118DOI: (10.1016/j.hrcr.2015.05.003) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Ablation of focal atrial extrasystoles (AEs) that degenerated into atrial fibrillation. A: Intracardiac electrograms showing recurrent AEs with earliest activation at CS 1,2 (black arrows). Under isoproterenol infusion, the coupling interval became shorter, then degenerated into atrial fibrillation. B: Intracardiac electrograms showing a small, fragmented signal (red arrow) on the distal mapping catheter prior to ablation at the lateral coronary sinus. C: Three-dimensional electroanatomic map of the right atrium, left atrium, and coronary sinus showing large areas of low voltage. Ablation at the lateral coronary sinus (red tags) eliminated the frequent AEs. HeartRhythm Case Reports 2016 2, 113-118DOI: (10.1016/j.hrcr.2015.05.003) Copyright © 2016 Heart Rhythm Society Terms and Conditions