Utility of a 64-pole basket catheter to detect non–pulmonary vein trigger in patients with paroxysmal atrial fibrillation

Figures

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  Figure 1. A: Cardiac tracing exhibiting the onset of atrial fibrillation (AF) triggered by an atrial premature complex (APC) originating from the lower right atrium. The earliest atrial activation of the APC (black arrowhead) is recorded at the G5-6 electrode of the 64-pole basket catheter. B: Voltage map of the right atrium and catheter position. Radiofrequency application to the green tag (white arrowhead) terminated the AF. CS = coronary sinus; PA = posteroanterior; RAO = right anterior oblique; TVA = tricuspid valve annulus.

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  Figure 2. A: Successful radiofrequency application and catheter positions. B: Atrial fibrillation terminates 3 seconds after radiofrequency application to the earliest activation site of the triggered atrial premature complex. ABL = ablation catheter; CS = coronary sinus; LAO = left anterior oblique; RAO = right anterior oblique; TVA = tricuspid valve annulus.

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  Figure 3. A: Representative intracardiac activation pattern of a non–pulmonary vein focus in case 2. The earliest atrial activation was recorded 14 ms ahead of P-wave onset by a 64-pole basket catheter. B: Catheter positions and representative ablation points on 3D mapping. Red tags are the ablation points from the right atrium, and the blue tags are from the left atrium. C: Catheter positions during radiofrequency application to the right atrial septum. ABL = ablation catheter; CS = coronary sinus; LAO = left anterior oblique; RAO = right anterior oblique; TVA = tricuspid valve annulus.