Intra-septal radiofrequency ablation within the transseptal puncture hole targeting an interatrial connection during a bi-atrial tachycardia

Figures

• 

  Fig. 1. (A) Twelve-lead electrocardiogram and (B–E) activation maps during the BiAT. The activation wavefront propagated from the inferior to anterior MA counterclockwise, then from the anterior MA to the high RA septum via the upper interatrial connection and returned to the inferior MA via the lower interatrial connection just at the transseptal puncture site. The yellow solid and dotted arrows represent the endocardial and interatrial conduction in the BiAT circuit, respectively, and the white arrows represent the endocardial conduction outside the BiAT circuit. The black and white tags and numbers on the maps indicate the conduction block, entrainment pacing sites, and PPI interval minus the TCL, respectively. Abbreviations: IVC, inferior vena cava; LAA, left atrial appendage; LIPV, left inferior pulmonary vein (PV); LSPV, left superior PV; MA, mitral annulus; RIPV, right inferior PV; RSPV, right superior PV; SVC, superior vena cava; TA, tricuspid annulus.

• 

  Fig. 2. Entrainment pacing from a mini-basket catheter placed inside the transseptal puncture hole, where continuous fractionated electrograms with a duration of 72 ms were recorded during the BiAT. The right panel shows the position of the mini-basket catheter on the three-dimensional geometry. Abbreviations: CS, coronary sinus recordings, Intra-septal EGM, intracardiac electrograms recorded by the mini-basket catheter. The other abbreviations are as in Fig. 1.

• 

  Fig. 3. Body surface and intracardiac electrocardiograms (A) just before commencing the radiofrequency application inside the transseptal puncture hole during the BiAT and (B) when the BiAT terminated. Continuous fractionated electrograms were recorded by the ablation catheter placed at the transseptal puncture site during the BiAT. (C) The intracardiac echocardiographic image and (D) right and left anterior oblique fluoroscopic images showing the position of the ablation catheter during the radiofrequency application that terminated the BiAT. Abbreviations: ABL, the tip of the ablation catheter; ABL 1–2 and 3–4, distal and proximal ablation catheter recordings. The other abbreviations are as in Fig. 1, Fig. 2.