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Utility of the ultra-high-resolution 3-dimensional mapping catheter for isolated pulmonary vein reentrant tachycardia

Published:October 19, 2017DOI:https://doi.org/10.1016/j.hrthm.2017.10.024
      A 72-year-old man with drug-refractory paroxysmal atrial fibrillation underwent a HotBalloon (Toray Industries, Tokyo, Japan) pulmonary vein (PV) isolation. The session was performed with the assistance of the Rhythmia system (Boston Scientific, Cambridge, MA), and a 64-electrode mini-basket catheter was used for left atrial mapping. An isolated PV tachycardia occurred spontaneously from the left superior pulmonary vein (LSPV) just after the PV isolation,
      • Ouyang F.
      • Bänsch D.
      • Ernst S.
      • et al.
      Complete isolation of left atrium surrounding the pulmonary veins: new insights from the double-Lasso technique in paroxysmal atrial fibrillation.
      and a high-density 3-dimensional activation map of the tachycardia was created. The tachycardia cycle length was 150 ms, and the reference of the tachycardia was obtained by placing the ablation catheter inside the LSPV. The activation of the tachycardia was difficult to analyze when the mini-basket catheter was moved; therefore, the catheter was kept still while the PV tachycardia was recorded. Double potentials were documented parallel to the long axis of the vein at the inferoposterior aspect of the LSPV, and a reentrant circuit formed around that double potential area (Supplemental Video). In addition, fractionated potentials were recorded on the proximal side of the LSPV. The cycle length of the fractionated potentials was 50 ms, which accounted for one-third of the entire conduction time of the tachycardia, suggesting the existence of slow conduction in that area.

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      Reference

        • Ouyang F.
        • Bänsch D.
        • Ernst S.
        • et al.
        Complete isolation of left atrium surrounding the pulmonary veins: new insights from the double-Lasso technique in paroxysmal atrial fibrillation.
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