Radiofrequency ablation data associated with atrioesophageal fistula

Figures

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  Figure 1. Sites of auto-annotated radiofrequency ablation with tag coloration using ablation index. CARTO (Biosense Webster Inc., Irvine, CA) posteroanterior view with procedural ablation index tag coloration 380–400. VISITAG preferences are shown (box); 2 mm tag radius in this image, for clarity.

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  Figure 2. Sites of auto-annotated radiofrequency (RF) ablation with impedance drop coloration. The first lesion in the posterior wall adjacent to the left inferior pulmonary vein (tag 24) is highlighted, showing RF data (box, from top to bottom: RF duration; power; tip temperature; impedance (range and drop); contact force (mean and range), force time integral; ablation index).

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  Figure 3. Auto-annotated radiofrequency (RF) tag 25 is highlighted, with accompanying RF data (box). RF at this site begins 21.9 seconds following RF completion at tag 24, at a 4.8 mm distance.

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  Figure 4. Auto-annotated radiofrequency (RF) tag 26 is highlighted, with accompanying RF data (box). RF at this site begins 4.7 seconds following RF completion at tag 25, at 4.9 mm distance.

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  Figure 5. Auto-annotated radiofrequency (RF) tag 27 is highlighted, with accompanying RF data (box). RF at this site begins 3.7 seconds following RF completion at tag 26, at 5.1 mm distance.

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  Figure 6. Auto-annotated radiofrequency (RF) tag 43 is highlighted, with accompanying RF data (box). At 19.6 Ω this is the fourth-greatest impedance drop site achieved at the left-sided left atrial posterior wall. RF at this site begins 1.1 seconds following RF completion at tag 42, at 5.3 mm distance.

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  Figure 7. Auto-annotated radiofrequency (RF) tag 44 is highlighted, with accompanying RF data (box). RF at this site begins 0.017 seconds following RF completion at tag 43, at 5.5 mm distance. A duration of 36.4 seconds is within guideline recommendations but, when delivered immediately consecutively to another lesion within 6 mm, might create excessive focal RF effect.

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  Figure 8. Auto-annotated radiofrequency (RF) tag 45 is highlighted, with accompanying RF data (box). RF at this site begins 0.016 seconds following RF completion at tag 44, at a 6.5 mm distance.

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  Figure 9. Auto-annotated radiofrequency (RF) tag 46 is highlighted, with accompanying RF data (box). RF at this site begins 5.4 seconds following RF completion at tag 45, at 3.3 mm distance. A duration of 38.5 seconds is within guideline recommendations but, when delivered shortly after another lesion within 6 mm, might create excessive focal RF effect. This site is also very close to the previous high impedance drop auto-annotated tags.

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  Figure 10. Auto-annotated radiofrequency (RF) tag 47 is highlighted, with accompanying RF data (box). RF at this site begins 24.5 seconds following RF completion at tag 46, at 2.2 mm distance. Although 23.7 seconds duration is within guideline recommendations, an impedance drop of 16 Ω might have contributed to excessive focal RF effect and atrioesophageal fistula.

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  Figure 11. Auto-annotated radiofrequency (RF) tag 114 is highlighted, with accompanying RF data (box). RF duration at this site is short and begins 331.0 seconds following RF completion at tag 113, at 6.2 mm distance.

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  Figure 12. Auto-annotated radiofrequency (RF) tag 115 is highlighted, with accompanying RF data (box). RF duration at this site is very short and begins 0.016 seconds following RF completion at tag 114, at 5.1 mm distance.