Single site radiofrequency catheter ablation of atrial fibrillation: studies guided by simultaneous multisite mapping in the canine sterile pericarditis model
Koichiro Kumagai, MDa,
Kikuya Uno, MDa,
Celeen Khrestian, BSa and
Albert L. Waldo, MD, FACCa
a Department of Medicine, Case Western Reserve University and the University Hospitals of Cleveland, Cleveland, Ohio, USA
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Figure 1 ECG lead II recorded simultaneously with bipolar electrograms from the stainless steel wire electrodes placed on the right atrial appendage (RAA), Bachmann’s bundle (BB) and the posterior-inferior left atrium (PLA) demonstrating recording during a representative example of induced atrial fibrillation. The ECG recording shows ventricular paced beats.
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Figure 2 Representative example of the sequence of activation maps during 12 consecutive 100 ms windows (total of 1.2 s of analysis) from an episode (dog 1) of atrial fibrillation. The colored lines indicate the location of unstable reentrant circuits. The gray arrows indicate the activation wave fronts that are not part of a reentrant circuit. Thin lines represent isochrones at 10 ms intervals. The thick dashed lines represent lines of functional block. The asterisk indicates the epicardial breakthrough point of the wave front coming from the septum. The dark gray regions indicate the atrial areas that were not activated during a 100 ms window. BB = Bachmann’s bundle area; CS = coronary sinus; IVC = inferior vena cava; LAA = left atrial appendage; PV = pulmonary vein; RAA = right atrial appendage; SVC = superior vena cava. See text for discussion.
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Figure 3 The locations of unstable reentrant circuits are shown. The unstable reentrant circuits were observed 1) involving the septum and the atrial epicardium via BB (56%) and not via BB (6%), and 2) in the right atrial free wall (21%), and were sometimes observed 3) around the pulmonary veins (7%), 4) the inferior vena cava (5%), and 5) the superior vena cava (5%). Three (#1, 3, 5; in total; 68%) of these five location reentrant circuits involved the BB (denoted by black lines). See text for discussion.
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Figure 4 Sequence of activation maps during the six consecutive 100 ms windows just before termination of transient AF after ablation in the same episode (dog 1) as shown in Figure 2. The black area in BB indicates a linear lesion created by radiofrequency catheter ablation. Note the absence of reentrant circuits of short cycle length in any window. The black line with arrows indicates the meandering course of activation along the atrial free wall. The right atrium was primarily activated by the wave fronts from the left atrium via the intercaval region. See text for discussion.
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Figure 5 This figure is a picture of a cross section of the lesion in the mid portion of BB created by the radiofrequency catheter ablation. The arrow points to the lesion. Note that the lesion is transmural.
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