1. Thoracoscopic Resection of the Left Atrial Appendage After Failed Focal Atrial Tachycardia Ablation 
Rachel D. Torok, MD, Benjamin Wei, MD, Ronald J. Kanter, MD, Robert D.B. Jaquiss, MD, Andrew J. Lodge, MD 
The Annals of Thoracic Surgery 
Volume 97, Issue 4, Pages (April 2014)
DOI: /j.athoracsur
Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Earliest atrial activation site of focal atrial tachycardia during point-to-point endocardial mapping from patient 3. (A) Intracardiac mapping, with ABL-d representing the electrograms from the distal bipole of the mapping/ablation catheter at the local activation site in the distal left atrial appendage. (B) Local activation map from point-to-point bipolar recording using NavX system. Superimposed are several of the ablation sites, with brown representing radiofrequency energy and light blue representing cryoenergy. The blue circle which is encircled in yellow corresponds to the site of the ABL-d electrograms in (A). (ABL = map/ablation catheter electrograms; CS = coronary sinus catheter electrograms [1 being most distal; 5 being most proximal, ie, closest to the coronary sinus ostium]; His = His bundle catheter electrograms [p, proximal; m, middle; d, distal]; LAA = left atrial appendage; LLPV = left lower pulmonary vein; LUPV = left upper pulmonary vein; MVA = mitral valve annulus; RF = radiofrequency.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
End of cryoablation attempt in distal portion of left atrial appendage from patient 3. (A) Intracardiac electrograms demonstrating abrupt slowing of focal atrial tachycardia just after termination of energy delivery. Asterisk (*) is adjacent to the distal ablation catheter's bipolar electrograms as the high amplitude electromagnetic noise dissipates. This represents loss of cryoadherance as the catheter “thaws.” Repeated heart rate slowing from this phenomenon indicates close proximity of the catheter tip to the anatomic origin of the tachycardia, because it never occurred at other sites. Tachycardia always resumed within seconds, however. (B) Anterior-posterior chest radiograph during cryoenergy application depicted in (A). The site of the ablation catheter (Abl) corresponds to the yellow-encircled light blue circle in Fig 1(A). (ABL = map/ablation catheter electrograms; CS = coronary sinus catheter electrograms [1 being most distal; 5 being most proximal, ie, closest to the coronary sinus ostium]; His = His bundle catheter electrograms [p, proximal; m, middle; d, distal]; RA = right atrial catheter electrograms [10 being most anatomically superior, 2 being most anatomically inferior]; RVA = right ventricular apical catheter electrograms.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Left atrial appendage (arrow) viewed from thoracoscope for patient 2.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Vascular load endo-GIA applied across the base of the left atrial appendage for patient 2.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions