Peak frequency mapping to differentiate the sinus node and superior vena cava during atrial fibrillation

Figures

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  Figure 1. High-density mapping during AF. High-density mapping during AF revealed a sharper annotated peak frequency in the SVC (A) than in the RA (B). When the peak frequency map and emphasis map were applied with a threshold of ≥350 Hz, the emphasis map highlighted the SVC region, whereas no emphasis was observed in the RA. Consequently, the SVC-RA junction was clearly delineated (dotted line). The blue tags correspond to the region of lesions for the emphasis map–guided ablation. An SVC isolation was successfully created by ablation in the highlighted area, which corresponded to the SVC region. AF = atrial fibrillation; RA = right atrium; SVC = superior vena cava.

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  Figure 2. The SVC was successfully isolated electrically. After direct current cardioversion, an electrical dissociation was observed within the SVC (A). After touch-up ablation, electrical isolation was confirmed using a 3-dimensional map (B). B: The blue tags were the region of lesions for the emphasis map–guided ablation, and the green tags were the touch-up site. White tags indicate locations where diaphragmatic stimulation was confirmed. The distance between the sinus node (blue circle) and the blue tags is 5 mm. SVC = superior vena cava.

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  Figure 3. Activation map (A) and emphasis map (B) during sinus rhythm revealed frequencies of 489 Hz in the RA and 602 Hz in the SVC, which were higher than those observed during AF. The blue tags are the region of lesions for the emphasis map–guided ablation. The white tags mark sites of confirmed diaphragmatic stimulation, and the dotted line represents the SVC-RA junction. AF = atrial fibrillation; RA = right atrium; SVC = superior vena cava.