Pulsed‐Field Ablation for Atrial Fibrillation in Partial Anomalous Pulmonary Venous Return With Right Atrial Drainage of Both Right Pulmonary Veins

Figures

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  FIGURE 1. Computed tomography‐based three‐dimensional reconstruction showing anomalous drainage of the right superior and right inferior pulmonary veins into the right atrium. The left pulmonary veins drain normally into the left atrium. IVC, inferior vena cava; LA, left atrium; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; LV, left ventricle; PLSVC, persistent left superior vena cava; RA, right atrium; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; SVC, superior vena cava.

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  FIGURE 2. Three‐dimensional electroanatomical voltage maps of the right and left atria, superior vena cava, and pulmonary veins in the posteroanterior view. (A) Pre‐ablation showing preserved antral potentials. (B) Post‐ablation demonstrating electrical isolation of both left and anomalous right pulmonary veins. IVC, inferior vena cava; LA, left atrium; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RA, right atrium; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; SVC, superior vena cava.

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  FIGURE 3. Right lateral view of three‐dimensional electroanatomical maps. (A) Local activation time map during sinus rhythm showing the sinus node region (white arrow) and the PulseSelect catheter positions at the antral regions of the right superior and right inferior pulmonary veins during pulsed‐field ablation. The distances from the sinus node region to the right superior and right inferior pulmonary vein ablation sites were 31 and 34 mm, respectively. (B, C) Pre‐ and post‐ablation bipolar voltage maps obtained in the same projection and displayed with the same voltage scale. The post‐ablation map demonstrates isolation of the anomalous right pulmonary veins, while the low‐voltage area adjacent to the sinus node region was already present before ablation. IVC, inferior vena cava; RA, right atrium; RIPV, right inferior pulmonary vein; RL, right lateral; RSPV, right superior pulmonary vein; SVC, superior vena cava.