A case report of successful treatment of longstanding persistent atrial fibrillation with ablation for fractionated potential with conduction delay during rapid pacing

Figures

• 

  Figure 1. A trigger and substrate of atrial fibrillation (AF) in the pulmonary vein (PV) and superior vena cava (SVC). AF termination simultaneously with the completion of PV isolation (PVI) may occur even if fibrillation is sustained in the PV. The red arrow is the time of PVI completion. A: The start of AF from the left superior pulmonary vein (LSPV). The ectopic beat that occurred in the LSPV with a coupling interval of 157 ms did not induce AF, but that with a coupling interval of 139 ms induced AF with a fractionated potential. B: AF from the SVC trigger. The electrograms demonstrated that the ectopic beats were repeated with short coupling intervals and prolonged and increased fractionated potential with conduction delay. C: The SVC electrogram stimulated by using the Advisor HD Grid A 1-2 (Abbott, Chicago, IL) with a cycle length of 240 ms. The first stimulation made the electrogram of the SVC, which showed a fractionated potential with conduction delay than in sinus beat; the subsequent electrograms of SVC were observed before the successive stimulation. D: The location of the Advisor HD Grid and ring catheter in the right atrium.

• 

  Figure 2. Electrogram characteristics provoking atrial fibrillation (AF) in the right superior pulmonary vein (RSPV). A: The start of AF from the RSPV. The red arrow is the ectopic beat that induces AF. B: The electrogram showing the stimulation of the RSPV using the ring catheter by coupling intervals of 300 ms. The red arrows in both directions represent the duration of the fractionated potential with conduction delay induced by the stimulus (B–D). C: The electrogram showing the stimulation of the RSPV using the ring catheter by coupling intervals of 260 ms. D: The electrogram showing the stimulation of the RSPV using the ring catheter by coupling intervals of 220 ms. E: The location of the Advisor HD Grid (Abbott, Chicago, IL) and ring catheter in the RSPV.

• 

  Figure 3. Normal and abnormal electrograms during rapid pacing in the atrial muscle. A: A normal electrogram on the Advisor HD Grid (Abbott, Chicago, IL) during rapid pacing, which shows a spiky appearance with high voltage and less fractionation. B: An abnormal electrogram on the Advisor HD Grid during rapid pacing, which shows a fractionated potential with conduction delay and low voltage. C: The voltage map before ablation with the red, pink, and white tags as the ablation points.