Electroanatomical properties and high-density mapping guided targeted isolation of superior vena cava

Figures

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  Fig. 1. Measurements performed in the study. A Sinus node EZ measurement: on the left, isochronal map of the RA with 10 first ms of CL visualized in red; on the upper right, EGM of the earliest signal, annotated 10 ms before the onset of the P wave in 12 lead ECG; on the lower right: corresponding steps of the isochronal map in ms. B Pace map of the PN (purple dots) and measurement of PN length (white dotted line). C Conduction block lines (white lines) between the SVC and RA in activation maps (D) Measurement of the length of electrically active SVC sleeves (white dotted line: SVC-RA junction). AP, anteroposterior; EGM, electrogram; EZ, exit zone; LL, left lateral; PA, posteroanterior; PN, phrenic nerve; RA, right atrium; RL, right lateral; SVC, superior vena cava

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  Fig. 2. Electrophysiological study of the SVC. A Position of the multipolar catheter with some splines 1-2, 3-4, 5-6, 7-8, 9-10, and 11-12 located above and splines 13-14, 15-16, 17-18, and 19-20 located below the block line. B Programmed stimulation from SVC splines 7-8, demonstrating decremental conduction from the SVC to the RA; speed 200 mm/s (C) ERP of the SVC: 270 ms (blue asterisk- sinus beat); speed 100 mm/s (D) Wenckebach of the SVC at CL 270 ms (red asterisk), speed 100 mm/s. CL, cycle length; ERP, effective refractory period; RA, right atrium; RL, right lateral projection; SVC, superior vena cava

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  Fig. 3. A Ablation of the SVC with closure of gaps between conduction block lines (red dots indicate ablation points). B Moment of electrical isolation of the SVC (white arrow). C Distances from the ablation lines to PN and SN. D Conduction velocity across the gap in the block line. AP, anteroposterior; LL, left lateral; PA, posteroanterior; PN, phrenic nerve; RL, right lateral; SN, sinus node; SVC, superior vena cava

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  Fig. 4. A Definition of four SVC segments in our study; (B) Location of the ablation line; (C) Location of PN with pace map; (D) Location of the SN-EZ (first 10 ms of activation). Ant, anterior; LL, left lateral; Post, posterior; RL, right lateral; SVC, superior vena cava, SN-EZ, sinus node exit zone

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  Fig. 5. A Median gap width and (B) median SVC sleeve length in each of four segments in the study cohort. Ant, anterior; LL, left lateral; Post, posterior; RL, right lateral; SVC, superior vena cava