Ultra-high-density mapping for safe and effective typical atrioventricular nodal reentrant tachycardia ablation.

Fig. 1. Activation during sinus rhythm and slow pathway potentials in Case 1 Fig. 1A: Activation during SR, showing the spread of activation from the FP and the SP up to the His bundle. Fig. 1B: Distribution of slow pathway potentials during SR. The JP is shown with a green tag and the His potential with a yellow tag. The JP is also shown on the LUMIPOINT algorithm. Fig. 1C: Activation during RV pacing, showing ventriculoatrial conduction during RV pacing observed at the same site as the orthodromic conduction. Fig. 1D: Ablation site and local potential observed with RF application at a recording site of the JP. A junctional rhythm appeared, with successful dissection of the SP achieved. FP: fast pathway SP: slow pathway CS: coronary sinus JP: Jackman potential RF: radiofrequency RV: right ventricle SR: sinus rhythm

Fig. 2. Tachycardia mapping in Case 2 Fig. 2A, 2B: Activation during SR (A) and RV (B) pacing. Ventriculoatrial conduction during RV pacing is observed at the same site as the orthodromic conduction. Fig. 2C: Tachycardia mapping, showing that the tachycardia circuit matched the orthodromic conduction and antidromic conduction visualized during SR and RV pacing. Identification of the optimal site for ablation allowed successful dissection of the SP to be achieved. FP: fast pathway CS: coronary sinus SP: slow pathway RV: right ventricle SR: sinus rhythm

Fig. 3. Analysis of the activation spread of the slow pathway for Case 3 Fig. 3A: Activation during SR, with the JP observed in the posterior septum; this site was also highlighted by the LUMIPOINT algorithm. SP conduction is also visualized at this site. Fig. 3B: Activation during CS ostium pacing, with only the SP conduction visualized. The conduction matched the conduction visualized during SR. Fig. 3C: Ablation site matched the SP site visualized during CS ostium pacing. FP: fast pathway SR: sinus rhythm JP: Jackman potential SP: slow pathway CS: coronary sinus

Fig. 4. The absence of slow pathway potentials in Case 4 Fig. 4A: Search for potentials during SR with no JP visualized after careful search using the Orion system. Fig. 4B: Ablation site located inside the roof of the CS. SR: sinus rhythm JP: Jackman potential CS: coronary sinus

Fig. 5. Characteristics and analysis of local potentials in Case 1 Fig. 5A: Characteristics of local potentials, showing the spread of activation from the FP (blue line), the JP (green lines), and the His potential (yellow lines). The height of the spiky JP increased as the site was in a higher position and the potentials split into the His potentials. Fig. 5B: Visualization of local potentials and junctional rhythm. The junctional rhythm appeared with ablation at the recording site of spiky potentials, with successful dissection of the SP achieved. Fig. 5C: Isochronal late activation map showing the speed of activation spread and slow conduction of the SP. At the site where activation entered the SP, the path of conduction turned in the vicinity of the CS and a functional block line was observed. FP: fast pathway SP: slow pathway A: atrium V: ventricle JP: Jackman potential CS: coronary sinus