Organization of atrial fibrillation using a pure sodium channel blocker: Implications of rotor ablation therapy

Figures

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  FIGURE 1. Schematic flowchart of the study protocol (upper panel) and segmentation of the left atrial surface into 11 parts (lower panel). center, center inferior area; LAA, left atrial appendage; left, left inferior area; low LPV, lower left pulmonary vein; Right, right inferior area.

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  FIGURE 2. (A) A phase map recorded in the left atrial roof before and after pilsicainide administration (upper two panels). The white line shows the wavefront. Emergence of wavefront was set at 0 ms. The wavefront propagated almost all the areas 24 ms later. After pilsicainide administration, the wavefront reached only half the area due to reduced conduction velocity. (B) A phase map recorded in the left atrial posterior wall in another patient before and after (lower two panel) pilsicainide administration. Before pilsicainide, one rotation was almost complete 120 ms later. After pilsicainide, the rotation remained semicircular in the same period.

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  FIGURE 3. (A) A 65‐year‐old male patient with wide area organization before and after pilsicainide administration. Left pulmonary vein is the common trunk. %NP value of septal, inferior, and lower posterior areas reduced drastically after pilsicainide administration, while those of anterior and lateral sites remained high. (B) Ablation point of the same patient and intracardiac electrogram. Two high %NP areas were targeted. During the lateral site encircling ablation, atrial fibrillation was converted into atrial tachycardia (asterisk). Red dot indicates the converted point. CS, coronary sinus; DF, dominant frequency. CS1‐2 is located in the distal CS and CS7‐8 is located in the proximal CS.

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  FIGURE 4. Persistent atrial fibrillation that lasted for 3 years in a 63‐year‐old female patient. (A) Phase maps were recorded in the anterior wall, left atrial appendage (LAA), and center of the inferior wall before and after pilsicainide administration. Anterior wall phase map showed rotational activity (upper left) and LAA (upper right) showed passive activity. Both excitation patterns were unchanged after pilsicainide administration. In contrast, the rotational activity disappeared in the inferior wall phase map (middle, right, and left panel) after pilsicainide administration. Lower panel: surface electrocardiogram (II lead) and intracardiac electrogram before (lower left) and after (lower right) pilsicainide administration. Atrial fibrillation cycle length was prolonged and the local signal was decreased and became less fragmented after pilsicainide administration. DF, dominant frequency; CS, coronary sinus. CS1‐2 is the distal site and CS7‐8 is a proximal site. (B) Ablation site (upper panel) and intracardiac electrogram at atrial fibrillation (AF) termination (lower panel). Linear ablation (white dot) was performed along the high %NP area. Red dot shows termination point of AF.…

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  FIGURE 5. Kaplan–Meier curve of arrhythmia‐free survival. (A) among the organized group, sustained group, and preliminary control. (B) between atrial fibrillation termination group and non‐termination group.