Journal: Europace

Article Title: Mapping and ablation outcomes of extra-pulmonary vein triggers in atrial fibrillation: single-centre retrospective study with consistent provocation protocol

doi: 10.1093/europace/euaf225

Figure Lengend Snippet: Representative example of an induced ExPVT from the LA septum during isoproterenol provocation test. ( A ) Intracardiac electrograms showing AF initiation by an ExPVT induced during provocation. The earliest activation (circle marked by a pointed arrow) is recorded by the circular mapping catheter positioned at the LA septum, consistent with panels D and E . ( B ) Fluoroscopic image (AP view) showing a left atriogram with pulmonary venogram and initial positioning of multielectrode diagnostic catheters. ( C ) Standardized catheter configuration (AP view) during provocation testing, including a quadripolar catheter in the SVC, a decapolar across the high RA and septum, and a duodecapolar along the CS and low RA. A PV mapping catheter, typically positioned at the LA posterior wall, varied in type depending on availability, operator preference, and patient characteristics. ( D ) Electroanatomical activation map identifying the earliest trigger point (white arrow) of the ExPVT from the LA septum. ( E ) Electroanatomical voltage map showing a low-voltage area at the LA septum compatible with the AF trigger site. Abbreviations: AF, atrial fibrillation; AP, anterior posterior; CS, coronary sinus; ExPVT, extra-pulmonary vein trigger; HRA, high right atrium; LA, left atrium; LRA, low right atrium; PV, pulmonary vein; RA, right atrium; SR, sinus rhythm; SVC, superior vena cava.

Article Snippet: Intracardiac electrograms were recorded using the Prucka CardioLabTM Electrophysiology system (General Electric Medical Systems, Inc., Milwaukee, WI, USA), and 3D electro-anatomical maps were created with the NavX (Abbott, Inc., Chicago, IL, USA) or CARTO (Biosense Webster, Diamond Bar, CA, USA) systems, using a PV-mapping catheter (Reflexion Spiral, AdvisorTM FL Circular, or HD Grid from Abbott, Inc.; AFocus, Lasso, PentaRay, or OctaRay from Biosense Webster, Inc.) through a long sheath.

Techniques: Activation Assay, Diagnostic Assay