Visualization of residual gaps after linear ablation using the LUMIPOINTTM module: A case report

Figures

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  Fig. 1. Settings for the LUMIPOINT activation window. Left panel (Step 1). The local activation time of the latest site in front of the linear ablation line (white rectangle) was −50 msec (Site A). The local activation time of the earliest site behind the linear ablation line was −21 msec (Site B). The time difference of 29 msec (−21 - (−50) = 29) was set as the LUMIPOINT activation window. Middle panel (Step 2). Using the set LUMIPOINT activation window, the LUMIPOINT with a CS value of 85 % (nominal setting) highlighted both sites A and B simultaneously (white line surrounded by white arrowheads indicates HAs.). Right panel (Step 3). When the CS value was lowered by 5–10 % (L-CS method), the HAs are gradually expanding (white circles), and finally two HAs fused (yellow circle) with the CS of 30 %. The red horizontal line (lines 1–3) indicates tolerance level for consistency with surrounding points. When the CS value is in the nominal setting (Line 1), most EGMs at diastolic phase are undetected. When the CS value is lowered (Line 2), a portion of EGMs at diastolic phase is detected. When the CS value is further lowered (Line 3), a large number of EGMs at diastolic phase are detected.…

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  Fig. 2. (A) Activation map during the roof-dependent atrial tachycardia. (B) L-CS method. (C) Successful ablation site (yellow arrow). (D) Unipolar and bipolar EGMs at successful ablation site. The voltage was 0.0405 mV. The duration of the fragmented potential was 98 ms. (E) Surface ECG, intracardiac recordings, and unipolar and bipolar EGMs at successful ablation site. EGMs in the red rectangle are magnified in Fig. 2-D. LAA = left atrial appendage, LAW = LUMIPOINT activation window, LSPV = left superior pulmonary vein, RSPV = right superior pulmonary vein. The other abbreviations are shown in Fig. 1. The white rectangle, white circle, and yellow circle were illustrated in the text of Fig. 1.

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  Fig. 3. (A) Activation map during the roof-dependent atrial tachycardia. (B) L-CS method. (C) Successful ablation site (yellow arrow). (D) Unipolar and bipolar EGMs at successful ablation site. The voltage at the successful ablation site was 0.0602 mV. The duration of the fragmented potential was 80 ms. (E) Surface ECG, intracardiac recordings, and unipolar and bipolar EGMs at successful ablation site. EGMs in the red rectangle is magnified in Fig. 3-D.The abbreviations are shown in Fig. 1, Fig. 2. The white rectangle, white circle, and yellow circle were illustrated in the text of Fig. 1.

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  Fig. 4. (A) Activation map during a peri-mitral flutter. (B) L-CS method. (C) Successful ablation site (yellow arrow). (D) Unipolar and bipolar EGMs at successful ablation site. The voltage at the successful ablation site was 0.0323 mV. The duration of the fragmented potential was 75 ms. (E) Surface ECG, intracardiac recordings, and unipolar and bipolar EGMs at successful ablation site. EGMs in the red rectangle are magnified in Fig. 4-D. LIPV = left inferior pulmonary vein. The other abbreviations are shown in Fig. 1, Fig. 2. The white rectangle, white circle, and yellow circle were illustrated in the text of Fig. 1.