Partial left superior pulmonary vein potential elimination by an inferior ganglionated plexus ablation

Figure 1. (A) Transparent view from the inside of the left atrium to the left lateral side. The green ring catheter is placed at the LSPV. Electrodes 1–10 on the ring catheter are located at the anterior part of the LSPV, while 11–20 cover the posterior part of the LSPV. LAA, left atrial appendage; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein (B) Intracardiac ECG showing the pre‐ablation LSPV potentials. The first potential from the anterior LSPV (green bracket) is the far‐field potential from the left atrial appendage. The second potential recorded from Libero electrodes 1–2 to 9–10 is from the anterior part of the LSPV (yellow bracket). The potential from Libero electrodes 11–12 to 19–20 exhibits the potentials from the posterior part of the LSPV (blue bracket) ABL, ablation catheter; Ant LSPV, anterior part of the left superior pulmonary vein; CS, coronary sinus; HRA, high right atrium; Post LSPV, posterior part of the left superior pulmonary vein; RVA, right ventricular apex; SVC, superior vena cava.

Figure 2. (A) RF application sites at the anterior part of the left PV, roof, anterior part of the right PV, and inferior GP ablation. The potentials from the anterior part of the LSPV are eliminated by the RF application at the inferior right GP (brown dot [white arrow]). The green ring catheter at the LSPV and white ablation catheter at the RF application site are displayed. GP, ganglionated plexus; LSPV, left superior pulmonary vein; PV, pulmonary vein; RF, radiofrequency (B) Intracardiac ECG showing the elimination of the PV potentials of the anterior part of the LSPV (yellow arrow). The potentials from the posterior part of the LSPV are unchanged (blue arrow). The first potential from the anterior LSPV (green arrow) is the far‐field potential from the left atrial appendage. Abbreviations are listed in Figure 1B.

Figure 3. (A) Total RF application sites during the AF ablation. The potentials from the posterior part of the LSPV were eliminated by the RF application at the anterior carina of the left PVs, which lead to a left PV isolation (blue dot [white arrow]). The green ring catheter at the LSPV and silhouette‐shaped ablation catheter at the RF application site are displayed. The abbreviations are listed in Figure 2A. (B) Intracardiac ECG showing the elimination of the potentials from the posterior part of the LSPV (blue arrow). The potentials from the anterior LSPV (green arrow) are the far‐field potentials from the left atrial appendage. The abbreviations are listed in Figure 1B.