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Circular mapping recordings in a persistent left superior vena cava during atrial tachycardia: Was isolation achieved?  Sandrine Venier, MD, Jason G.

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Presentation on theme: "Circular mapping recordings in a persistent left superior vena cava during atrial tachycardia: Was isolation achieved?  Sandrine Venier, MD, Jason G."— Presentation transcript:

1 Circular mapping recordings in a persistent left superior vena cava during atrial tachycardia: Was isolation achieved?  Sandrine Venier, MD, Jason G. Andrade, MD, Paul Khairy, MD, PhD, Laurent Macle, MD, FHRS  HeartRhythm Case Reports  Volume 1, Issue 5, Pages (September 2015) DOI: /j.hrcr Copyright © 2015 Heart Rhythm Society Terms and Conditions

2 Figure 1 A: Simultaneous recordings of surface ECG leads II, III, and V1 and intracardiac coronary sinus (CS) and persistent left superior vena cava (PLSVC) electrograms during atrial fibrillation (AF) initiation. The circular mapping catheter is positioned within the PLSVC. During the first 2 sinus beats, left atrial far-field signals (arrow) are recorded first, followed by PLSVC signals (asterisk). During AF initiation, a reversal of the activation sequence is observed, with PLSVC potentials recorded very early (star) compared to the P wave on the surface ECG and to the atrial signals recorded on the CS catheter. Of note, the atrial activation sequence is from distal to proximal on the CS during AF initiation, indicating a probable left atrial origin. The AF cycle length is shorter in the PLSVC than in the CS. B: The circular mapping catheter is still positioned within the PLSVC during the atrial tachycardia originating from the CS. Spontaneous PLSVC potentials (*) distinct from the atrial far-field signals (A) are observed on the circular mapping catheter. HeartRhythm Case Reports 2015 1, DOI: ( /j.hrcr ) Copyright © 2015 Heart Rhythm Society Terms and Conditions

3 Figure 2 A: Simultaneous recordings of surface ECG leads II, III, and V1 and intracardiac coronary sinus (CS) and persistent left superior vena cava (PLSVC) electrograms during sinus rhythm after PLSVC isolation. The circular mapping catheter is positioned within the PLSVC. Note the complete absence of PLSVC potentials compared with the baseline recording during the first 2 beats in Figure 1A. B: Pacing is performed from the ablation catheter (Map 1–2) positioned in the left atrial appendage (LAA). The potentials recorded on the circular mapping catheter immediately follow the stimulus artifact on the anterior bipoles (arrows), confirming that these potentials represent LAA far-field signals. C: Shown is a fluoroscopic image of the circular mapping catheter positioned in the PLSVC in front of the LAA, the CS catheter, and the ablation catheter within the CS during AT ablation. Bipoles 3–4, 15–16, and 17–18 are anterior and close to the LAA (arrows). D: An angiographic image (anteroposterior view) of the CS and PLSVC is depicted. HeartRhythm Case Reports 2015 1, DOI: ( /j.hrcr ) Copyright © 2015 Heart Rhythm Society Terms and Conditions

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