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Figure 1 Ablation Lesions and Lead Placement
Isolation of small atrial segment surrounding the atrioventricular node and the His bundle was achieved by sequential radiofrequency ablation. The structures around the Koch triangle in the swine heart are shown here. The relative location of the CS and the IVC is different from that in humans. Please see text for details. The location of the tricuspid annulus is labeled. In this study, the His bundle is mapped first. The atrioventricular node is presumably just proximal and inferior to the His bundle. The small atrial segment surrounding the atrioventricular node and the His bundle is isolated using a series of radiofrequency ablation lesions. The isolation is started with a line crossing the CS–tricuspid isthmus, which is extended superiorly along the anterior edge of the CS. A pacing lead is inserted into the isolated atrial segment surrounded by the ablation lines, the tricuspid annulus, and the atrioventricular node–His bundle. The results of this study are not dependent on the location of the lead implantation (either closer to the AV node or closer to the CS–tricuspid isthmus). The circles labeled as A.B.L.A.T.I.O.N.L.I.N.E. represent the linear ablation lesions. Attain = steerable guiding sheath; AVN = location of the atrioventricular node; CS = coronary sinus; HB = the location of the His bundle; IVC = inferior vena cava.
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