Atrial flutter following ethanol infusion in the vein of Marshall

Figures

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  Figure 1. Left atrial activation map: A: caudal view; B: left anterior oblique (LAO) cranial view. C: Intracardiac electrogram between left pulmonary vein and left atrial appendage (LAA) and coronary sinus (CS). Round pink tags in panel B represent where abnormal electrogram was observed. LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein.

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  Figure 2. Intracardiac electrograms. Post-pacing interval at mitral isthmus (A) and at the site between the left pulmonary vein and left atrial appendage (B).

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  Figure 3. Voltage maps of left atrium during tachycardia. A: After ethanol infusion in the vein of Marshall (VOM) in the previous session. B: In the present session. C: Before ethanol infusion in the VOM in the previous session. Because the period between previous and present session was 1 month, the computed tomography images that were used for CARTO-merge in the present session were the same as those used in the previous session. Round red tags represent ablation point using ablation catheter (ThermoCool SmartTouch, Biosense Webster) in addition to ethanol infusion in the VOM to obtain complete block line of mitral isthmus. Round pink tags in panel B represent the point where abnormal electrogram was observed. LAA = left atrial appendage; LAO = left anterior oblique; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein.