Peak Frequency–Guided Cardioneuroablation and Pulmonary Vein Isolation in Sinus Node Dysfunction and Atrial Fibrillation

Figures

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  Figure 1. Baseline Electrocardiogram Surface electrocardiogram in lead II before the procedure showing sinus bradycardia, with a heart rate of 40 beats/min.

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  Figure 2. Preprocedural Electrophysiological Study Intracardiac electrogram from the baseline electrophysiological study demonstrating a prolonged sinus node recovery time of 4,730 ms.

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  Figure 3. Electroanatomic Mapping of Fractionated Atrial Potentials Three-dimensional electroanatomic mapping showing fractionated atrial potentials localized to the anterior wall of the right superior pulmonary vein.

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  Figure 4. Fractionation and Peak Frequency Maps of the Left Atrium Three-dimensional electroanatomic maps integrating high-resolution fractionation mapping and peak frequency analysis. FAPs were visualized on the left atrial geometry (dots), with overlaid peak frequency mapping highlighting regions exhibiting high-frequency components exceeding 400 Hz. Concordant sites demonstrating both fractionation and high-frequency activity were localized at the anterior aspect of the RSPV (yellow arrow), which was targeted for selective cardioneuroablation. FAP = fractionated atrial potential; RSPV = right superior pulmonary vein.

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  Figure 5. Postablation Sinus Node Recovery Time Electrophysiological assessment after PVI and CNA demonstrating a significant improvement in the SNRT. The heart rate normalized to 68 beats/min. CNA = cardioneuroablation; PVI = pulmonary vein isolation; SNRT= sinus node recovery time.

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  Figure 6. Electrocardiogram at 1-Year Follow-Up Surface electrocardiogram at the 1-year follow-up demonstrating stable sinus rhythm without recurrence of atrial fibrillation or symptomatic bradycardia.

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  Visual Summary. Mapping-Guided Dual Ablation for SND and AF