The impact of left atrial inferior wall isolation, in addition to pulmonary veins and left posterior wall, on long-standing persistent atrial fibrillation

Figures

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  Figure 1. A: Shorter coupling and fractionated potential during atrial fibrillation (AF) observed in the left atrial inferior wall (LAIW). B: Catheters were placed in the right atrium (RA), left inferior wall, and coronary sinus (CS). C: The orange tags show the linear ablation performed from the bottom of the right inferior pulmonary vein to the mitral annulus, with the green tags showing the mitral isthmus block line. The black arrow shows the conversion of atrial fibrillation (AF) to atrial tachycardia (AT) in the RA at the inferior site of the mitral annulus. D: Tachycardia cycle length was prolonged and AF was changed to AT in the RA. E: Change of the AT to a sinus rhythm in the RA, but with sustained AT in the LAIW and CS; the black arrowhead shows the P wave of sinus rhythm. ABL = ablation catheter.

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  Figure 2. A: Right atrium (RA) burst pacing at 400 ms transmitted to the left atrial inferior wall (LAIW) and the coronary sinus (CS) via a 2-to-1 conduction pattern. B: LAIW burst pacing at 450 ms conducted to the RA, via a 2-to-1 pattern, and to the CS, via a 1-to-1 conduction pattern. The ablation catheter was located at the LAIW. ABL= ablation catheter.

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  Figure 3. A: The left atrial inferior wall (LAIW) and the coronary sinus (CS) were isolated simultaneously (black arrow). B: Dissociated potentials were observed from the LAIW, which captured only the CS (black arrowhead). C, D: Radiofrequency application at the bottom of the CS resulting in isolation of the CS and LAIW (red arrow). ABL = ablation catheter; RA = right atrium.