Takekuni Hayashi et al. JACEP 2016;2:27-35

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Presentation transcript:

Takekuni Hayashi et al. JACEP 2016;2:27-35 Examples of PMAT Using LOM (A) The tachycardia activation sequences of the VOM and CS were distal to proximal, which indicated the presence of MB-LA connections and MB–distal CS connections (case 3) (left panel). The PPI was equal to the tachycardia cycle length (TCL) from the VOM pacing during tachycardia. The difference between PPI and TCL from the CS 1 to 2 was 35 ms (i.e., out of re-entrant circuits) (right panel). (B) In case 3, the potentials of the ablation catheter at the ridge showed fractionated potentials that lasted 170 ms. Radiofrequency was applied at this site during tachycardia, and the tachycardia was successfully terminated. At the beginning of the ablation, the activation sequences of CS were distal to proximal. During the ablation, the wave fronts changed to activate from CS 3 to 4 to CS 1 to 2 and CS 5 to 8. These observations indicated that ridge ablation had disconnected the MB–distal CS connections as well as the MB-LA connections. (C) The fluoroscopic catheter positioning in case 3. The bifurcation of CS and VOM is positioned at CS 3 to 4. (D) The tachycardia activation sequences of cases 4 and 5 were the reverse of case 3. The potentials of the ablation catheter at the ridge also showed fractionated continuous potentials that lasted 155 ms (case 4) and 120 ms (case 5). The PPI was equal to the TCL from the ablation catheter pacing during tachycardia. In both cases, tachycardia was terminated by radiofrequency ablation at these sites. LAO = left anterior oblique; RA = right atrium; other abbreviations as in Figures 1 and 2. Takekuni Hayashi et al. JACEP 2016;2:27-35 American College of Cardiology Foundation