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Figure 3 Ostial ablation of left superior pulmonary vein (LSPV) with three distinct breakthroughs using the earliest activation mapping. At baseline, among late pulmonary vein potentials (PVPs) in all bipoles, PVPs in both bipole 1to 2, 2 to 3 and 6 to 7, 7 to 8 (asterisk) showed slight precocity during distal coronary sinus pacing. A radiofrequency (RF) application at bipole 6 to 7, 7 to 8 (asterisk = bottom of the vein) delayed the local conduction by eliminating breakthrough at this site and revealed a secondary breakthrough at the top of the vein (intermediate 1). Another RF delivery at this site (asterisk) of secondary breakthrough eliminated all PVPs except three bipoles (intermediate 2). Finally, further RF delivery targeting the remaining PVPs at bipole 8 to 9, 9 to 10 and 10 to 1 (asterisk = posterior wall of the vein) eliminated all PVPs and disconnected this vein from the left atrium. A reversal of the electrogram polarity was retrospectively observed at each electrical breakthrough site. I–III and V1 represent recordings from 12-lead surface ECG.
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