Figure 1
Twelve-lead electrocardiogram during the atrial tachycardia of 105 bpm with a positive notched P wave in leads I, II, III, aVF, V1, and V2.
Intracardiac electrograms during the atrial tachycardia with an unstable cycle length of 260 to 310 ms.
I, aVF, V1 = surface electrogram; CS = coronary sinus; RA = right atrium. The arrow marker indicates the initiation of atrial tachycardia.Figure 2
Intracardiac electrograms of atrial tachycardia with catheter placement in the left inferior pulmonary vein.
Activation map in left atrium during atrial tachycardia.
The earliest activation site of atrial tachycardia was observed at the bottom of the left inferior pulmonary vein ostium.
Cryoballoon ablation of the left superior pulmonary vein orifice and antrum resulted in termination of atrial tachycardia.
AT = atrial tachycardia; LAO = left anterior oblique view; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; PA = postero-anterior view. The other abbreviations are as in Figure 1. The arrow marker indicates the earliest activation site of atrial tachycardia.Figure 3
Left panel: Fluoroscopic image of a circular mapping catheter placed at the left inferior pulmonary vein ostium at the earliest activation site of atrial tachycardia. Middle panel: Fluoroscopic image during cryoballoon ablation of the left superior pulmonary vein. Right panel: Fluoroscopic image during cryoballoon ablation of the left inferior pulmonary vein.
The dotted line corresponds to the bottom of the left inferior pulmonary vein.
Vagal response observed after the completion of cryoballoon ablation of the left superior pulmonary vein. Transient atrioventricular block was observed during left atrial appendage pacing due to the appearance of sinus arrest.
The other abbreviations are as in Figure 1.