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Isolation of the conduction between the Marshall bundle and distal coronary sinus and the entire coronary sinus for an atrial tachycardia after catheter.

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Presentation on theme: "Isolation of the conduction between the Marshall bundle and distal coronary sinus and the entire coronary sinus for an atrial tachycardia after catheter."— Presentation transcript:

1 Isolation of the conduction between the Marshall bundle and distal coronary sinus and the entire coronary sinus for an atrial tachycardia after catheter ablation of atrial fibrillation  Daisuke Wakatsuki, PhD, Taku Asano, PhD, Hiroshi Mase, Masaaki Kurata, Hisa Shimojima, PhD, Hiroshi Suzuki, PhD  HeartRhythm Case Reports  Volume 3, Issue 7, Pages (July 2017) DOI: /j.hrcr Copyright © 2017 Heart Rhythm Society Terms and Conditions

2 Figure 1 Standard 12-lead electrocardiogram at the time of the atrial tachycardia. The P waves are negative in lead I and positive in leads II, III, aVF, and V1. The red arrow delineates the P wave. HeartRhythm Case Reports 2017 3, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

3 Figure 2 A: Fluoroscopic image (anterior-posterior view) of the coronary sinus (CS) and branch of the vein of Marshall (VOM), and the intracardiac electrocardiogram (ICE) recordings. By a contrast injection from the tip of the irrigated ablation catheter (ABL), the VOM was identified. Ao = electrode catheter as a reference in the aortic cusp; Eso = thermometer in the esophagus; LAA = ring catheter in the left atrial appendage; RV = right ventricle. B, C, D: The intracardiac electrograms for measuring the post pacing interval (PPI) at CS proximal (B) and left atrial (LA) ridge (C) and during the termination with ablation (D). The PPI at both sites (B and C) matched the tachycardia cycle length. D: Before the ablation the earliest activation site was at the CS mid (red arrow). After the atrial tachycardia terminated, the sequence of the CS potentials changed from proximal to distal. HeartRhythm Case Reports 2017 3, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

4 Figure 3 Activation map during the atrial tachycardia constructed with a NavX system. The numbers in the figure show the post pacing interval (PPI) at 7 typical points. The red circles represent the sites at which the PPI matched the tachycardia cycle length, and the black circles represent the sites at which the PPI did not match the tachycardia cycle length. ① 4 o'clock position on the mitral isthmus, ② 7 o'clock position on the mitral isthmus, ③ anterior ridge of the left superior pulmonary vein (PV), ④ posterior wall of the left atrium (LA), ⑤ near the mitral isthmus of the LA, ⑥ LA roof, ⑦ right superior PV. HeartRhythm Case Reports 2017 3, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

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