Real-time multielectrode mapping of pulmonary vein gap closure

A 59-year-old female patient underwent pulmonary vein isolation (PVI) reprocedure for recurrent atrial fibrillation. A high-density map performed with Advisor HD Grid catheter (Abbot St Paul, MN, USA) revealed a high-voltage area in the right superior pulmonary vein (PV) (Figure). In order to identify the gap responsible for the PV reconnection, a real-time activation map (RTAM) of the PV potential was performed using LiveView module (Abbott, St Paul, MN, USA). At many points it was observed an incorrect annotation of the local activation time (LAT) on the far-field signal of the left atrium. In order to correct this, the window of interest was modified by applying a blanking of the far-field signal, allowing selective mapping of the delayed PV potential. Automatic annotation without applying the blanking of the far-field signal suggested the location of the gap at the carina region (Panel B). Instead, selective mapping of the PV potential located the gap at the posterior region of the right superior PV (Panel A). A single radiofrequency application at this point achieved effective PVI, which was checked with RTAM (Supplementary material online, Video S1Supplementary material online,Video S1). This case proposes a method to avoid incorrect LAT annotation by applying a blanking of the far-field signal.

Source: Europace - June 2, 2021 Category: Cardiology Source Type: research