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Figure 1 Cineangiographic views (A) of catheter layout in a patient undergoing defibrillation-guided mapping and RF ablation of AF secondary to a focus in the right superior pulmonary vein, just inside the orifice (Patient 2). (B) Recording of spontaneous AF reinitiation in a patient with a focus just inside the RSPV (same Patient as in A). At the site of putative focus, the atrial electrogram during sinus rhythm is fragmented. A rapidly discharging focus with fragmented electrograms and a reproducible coupling interval of 200 ms to the sinus beat initiates a nonsustained, then a sustained run of AF. The first beat of the focus (*) is 115 ms (not labeled) ahead of the high right atrial electrogram (RA A9–A10) There was shortening of the cycle length after the first beat of the focus before the onset of AF. Because of the rapidity of the tachycardia, some electrograms appeared to be blocked (second and fourth beat after *). Note a similar activation sequence of the RA, but earlier activation of HIS and RAW electrograms at the first beat of the tachycardia compared to the sinus beat, with advancement of all CS electrograms suggestive of a LA focus. ABL = ablation catheter (at RSPV); CS = coronary sinus (B9, B10 = proximal CS; B1, B2 = distal CS); HIS = His bundle; LAO = left anterior oblique view; RA = right atrium (A9, A10 = high RA; A1, A2 = low RA); RAO = right anterior oblique view; RAW = high right interatrial septum; RV = right ventricular apex; RSPV = right superior pulmonary vein. Each calibration mark on the left represents 1 mV for that and the following recordings until a change in calibration was made.
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