A 58‐year‐old woman was referred for radiofrequency catheter ablation of drug‐refractory paroxysmal atrial fibrillation. A BOX isolation, with a complete isolation of the posterior wall of the left atrium (LA), including all pulmonary veins (PVs), was performed, but entrance conduction through the anterior aspect of the right PV remained. Additional ablation beside the initial line only resulted in a shift of the earliest activation to the carina region between the right superior and inferior PVs. Mapping of the right atrium (RA) during pacing from the right PV revealed an exit site at the posterior wall of the RA facing the carina region. Ablation at that site eliminated the exit conduction. However, there was an acute reconnection through there. An activation map during pacing from the coronary sinus and right superior PV, respectively, revealed an entrance site at the carina region of the right PV and an exit site at the posterior wall of the RA adjacent to the septum (Figure A and B). Further ablation at that exit site successfully completed the BOX isolation (Figure C).A, Activation map during pacing from the coronary sinus showing the entrance site at the carina region of the right PV. B, Activation map
Journal of Cardiovascular Electrophysiology – Wiley
Published: Jan 1, 2018
Keywords: ; ; ;
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