First application of the varipulse™ catheter for linear ablation in atrial fibrillation: a case report

Figures

• 

  Figure 1. PFA for pulmonary vein isolation and linear ablation in the left atrial intracardiac electrocardiogram shows AF. Left atrial substrate mapping while the AF remained ongoing (A,B). Successful completion of PV potential isolation and mitral isthmus line ablation, AF was converted into atrial flutter with a cycle length of 170 ms and demonstrated eccentric conduction with early CS1-2 polar atrial waves (C). Reinforcing linear ablation of the mitral isthmus, the atrial flutter presented a cycle length of 210 ms and exhibited eccentric conduction marked by early CS9-10 polar atrial waves (D,E). Perform BOX ablation on the posterior wall of the left atrial (F). AF, atrial fibrillation; PV, pulmonary vein.

• 

  Figure 2. The ablation lines in the PVVs and MI were appeared distinct. The ablation line within the pulmonary vein antrum and mitral isthmus vestibule appeared distinct (A–C). MI, mitral isthmus; LPV, Left pulmonary vein; RPV, right pulmonary vein.

• 

  Figure 3. Mapping of left atrial activation patterns and right atrial dual reentrant circuits. The propagation pattern in the left atrial revealed that the atrial septum was excited earlier (A). The right atrial substrate mapping clearly showed a low-voltage area in the right atrial (B). The activation mapping revealed the two reentrant loops in the right atrial, one traveled around the tricuspid annulus, and the other around the surgical incision (C,D).

• 

  Figure 4. Linear ablation of tricuspid isthmus and surgical incision. Ablated the tricuspid isthmus to halt atrial flutter and validated the tricuspid isthmus line block after the surgical procedure (A,B). Continued linear ablation along the incision towards the inferior vena cava (C). The series of images comprehensively illustrates the technique of the VARIPULSE™ catheter adhesion to the isthmus of the tricuspid valve (D).