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Figure 5 Example of a wide synchronous wave front showing the usefulness of electrogram polarity reversal. Ostial ablation of the left superior pulmonary vein (LSPV) was performed with two distinct breakthroughs using polarity reversal mapping. (Left) At baseline, late pulmonary vein potentials (PVPs) in all bipoles showed nearly synchronous activation during distal coronary sinus pacing, with two regions of electrogram polarity reversal in anterior (bipoles 2 to 3, 3 to 4 and 4 to 5, marked with a solid circle) and posterior wall (bipoles 6 to 7 and 7 to 8, marked with an asterisk). (Middle) A radiofrequency application at bipoles 6 to 7 and 7 to 8 (asterisk) with an electrogram polarity reversal (magnified traces are shown in the inset) delayed the local conduction by eliminating a breakthrough at this site. Then, another breakthrough showing both the earliest activation and an electrogram polarity reversal at bipoles 2 to 3, 3 to 4 and 4 to 5 (solid circle) became more apparent (across over three bipoles, magnified traces are shown in the inset). (Right) A radiofrequency application at this site of secondary breakthrough (solid circle) eliminated all PVPs. I–III and V1 represent recordings from 12-lead surface ECG.
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