Left atrial dissection as a trigger for recurrent atrial fibrillation

Figures

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  Figure 1. Local region of dyssynchronous contraction. A: Location of the multipolar catheter on intracardiac echocardiography; B: the corresponding location on the voltage map; C: the signals in this region during sinus rhythm. Pole A, B, C, and D correspond with the local signals seen on the multipolar catheter.

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  Figure 2. Effect of coronary sinus (CS) pacing on generation of atrial fibrillation (AF) signals. Shown are examples of the signals on the multipolar catheter (A, B, C, D labeled electrograms) during pacing of the CS. A: Disorganization of the local signals in the region of interest shown in Figure 1, though the isthmus labeled catheter (along the lateral right atrium) and CS labeled catheter (in the coroanry sinus) show an organized rhythm. B: Sustained AF throughout the heart. For review of induction of each see Supplementary Video 2, A and B.

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  Figure 3. Ablation of endocardial surface to eliminate complex, near-field potentials. Ablation was performed along the endocardial surface to eliminate the complex signals. Left and middle panels show pre- and post-ablation, respectively (below: noted inset of atrial electrogram on ablation catheter pre- and post-ablation). Right panel demonstrates the echogenicity of the ablated tissue.