Why the study?
Can high-resolution activation mapping identify and guide ablation of multiple epicardial connections during extensive pulmonary vein isolation?
Can high-resolution activation mapping identify and guide ablation of multiple epicardial connections during extensive pulmonary vein isolation?
High-resolution activation mapping can effectively identify spared epicardial PV-LA connections outside the PVI line, enabling targeted ablation to achieve complete isolation.
High-resolution pacing mapping may aid isolation in difficult PVI cases; leaves open need for prospective outcome data.
A 76-year-old male underwent a pulmonary vein isolation (PVI) of atrial fibrillation. The first-pass encirclement did not isolate the left superior PV (LSPV). High-resolution activation mapping during LSPV pacing identified the earliest activation site (EAS) on the left atrial (LA) roof outside the PVI line. A radiofrequency application on the roof isolated the LSPV. Thereafter, an LSPV reconnection occurred. Second activation mapping during LSPV pacing identified the EAS at the bottom of the ridge outside the PVI line. Radiofrequency applications targeting the EAS eliminated the LSPV reconnection. The multiple residual connections may be associated with spared epicardial PV-LA connections.
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Nakamura et al. (2020) studied this question.
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