Post on 26-Jun-2020
Figure 6.1A.
Figure 6.1B.
Figure 6.1C.
III
V1
RAA
HBp
HBD
CSp
CSD
RV
CTd
CTP
200 ms
H H H H H H
200 ms
III
V1
RAA
HBp
HBD
CSp
CSD
RV
CTd
CTP
H H H H
Figure 6.1D.
Figure 6.2A.
Figure 6.2B. 100 ms
RV
RAA
V1
II
HBp
HBd
CSd
CSp
I
H
Figure 6.2C
RV
RAA
V1
II
HBp
HBd
CSd
CSp
I
100 ms
Figure 6.2D 100 ms
RV
RAAV1
II
HBp
HBd
CSd
CSp
I
MAPp
MAPd
UNI-1
UNI-2
Figure 6.3A
H
100 ms
RV
RAA
V1
II
HBp
HBd
CSd
CSp
I
Figure 6.3B100 ms
RAA
V1
II
HBp
HBd
CSd
CSp
I
RV
MAPP
MAPd
UNId
UNIP
A
Figure 6.3C200 MS
RAA
V1
II
HBp
HBd
CSd
CSp
I
RV
MAPP
MAPd
UNId
UNIP
Figure 6.3D100 MS
RAA
V1
II
HBp
HBd
CSd
CSp
I
RV
MAPP
MAPd
UNId
UNIP
H
Figure 6.3E 300 MS
RAA
V1
II
HBp
HBd
I
RV
MAPP
MAPd
UNI-1
UNI-2
Figure 6.3F
RAA
V1
II
HBp
HBd
CSd
CSp
I
RV
MAPP
MAPd
H
100 MS
Figure 6.4A
H
CSP
RV
HBd
RAA
V1
I
CSD
HBp
Crista p
Crista d
100 MS
Figure 6.4B 100 ms
Anteroseptal Pacing Anterolateral Pacing
* *V
A
RV
RAA
V1
II
HBp
HBd
CSd
CSp
I
MAPP
MAPd
UNI-1
UNI-2
A A
A A
V V
Figure 6.4C100 MS
RV
RAA
V1
II
HBp
HBd
CSd
CSp
I
CS Pacing RAA Pacing
*
*
A
V
A V VA
Figure 6.4D
RH
RAA
V1
II
HBp
HBd
CSd
CSp
I
MAPP
MAPd
UniD
UniP
100 MS
RAA Pacing
*
*
A
VA
V
H
CS Pacing
AV
Aorta
HB
Mitral AnnulusTricuspidAnnulus
CentralFibrous Body
LAO Projection
Figure 6.5A
HBHB
RAARAA
CS CS
ABLABL
RAO LAO
Subclavian or internal jugular approach:
Figure 6.5B
Figure 6.5C
Ablation Catheter
Ablation Catheter
RAARAA
HB
CS
RAO Projection LAO Projection
100 ms
RAA
V3
V1
HBp
HBd
CSd
CSp
I
A A
Figure 6.6A
Figure 6.6B
CSP
RV
HBd
RAA
V1
I
CSD
HBp
MAPd
MAPp
UNI-1
UNI-2
CSP
RV
HBd
RAA
V1
II
CSD
HBp
MAPP
UNID
MAPD
UNIP
I
Figure 6.6C
Figure 6.6D100 ms
RAA
HBp
HBd
CSd
CSp
V1 V1
A2
A A’V V
V3
V1
I
Figure 6.6E
Figure 6.7A
CSP
RV
HBd
RAA
V1
I
CSD
HBp
ABLd
ABLp
UNI-1
UNI-2
100 ms
A A
Figure 6.7B
CSP
RV
HBd
RAA
V1
I
CSD
HBp
ABLd
ABLp
RF
UNI-1
UNI-2
Figure 6.7C
H
CSP
RV
HBd
RAA
V1
I
CSD
HBp
ABLd
ABLp
UNI-1
UNI-2
100 ms
AVN
HB
Figure 6.8A
Figure 6.8B
Figure 6.8C
RAA
V1
II
HBp
Cristad
CSd
CSp
I
HBp
Cristad
H H
100 ms
Figure 6.8D
RAA
V1
II
HBp
HBd
CSd
CSp
I
V5
100 ms
RV
A
V V
Hr
Hr
Figure. 6.9A
Figure 6.9B
CSP
RV
HBd
RAA
V1
I
CSD
HBp
MAPd
MAPp
UNI-1
UNI-2
Figure 6.9C
CSP
RV
HBd
RAA
V1
I
CSD
HBp
MAPd
MAPp
SCS SCS
SRV
V V’
UNI-1
UNI-2
Figure 6.9D
CSP
RH
HBd
RAA
V1
I
CSD
HBp
MAPd
MAPp
UNI-1
UNI-2
CSP
RV
HBd
RAA
V1
I
CSD
HBp
MAPd
MAPp A
APPUNI-1
UNI-2
Figure 6.9E
CSP
HBd
RAA
V1
II
I
CSD
HBp
CRYOP
CRYOD
UNI-2
UNI-1
Figure 6.9F
Figure 6.10A
Figure 6.10B
CSP
HBd
RAA
V1
CSD
HBp
I
HB
AP
100 ms
CSP
HBd
RAA
V1
I
CSD
HBp
MAPp
MAPd
II
RV
CS Roof
RAA
RV
HB
LAO
MS-MA
Fig. 6.10C
CSP
RV
HBd
RAA
V1
II
CSD
HBp
MAd
MAp
TAd
TAp
I
Fig. 6.10D
100 ms
CSP
HBd
RAA
V1
I
CSD
HBp
TAd
TAp
II
CSP
HBd
RAA
V1
I
CSD
HBp
MAd
MAp
II
Fig. 6.10E
10 W
34 V
0.3 A
1 secRF On
Fig. 6.10F
Figure 6.11A
A
A
HA
H
V
S
I
II
V1
RAA
LVp
LVd
RV
III
S
Anteroseptal LV Noncoronary Cusp
AP-P
Late LocalVentricularActivation
Figure 6.11B
RA
LAO Projection
RVHB
RV
RA
HB
Non-Coronary Cusp
Pullback from LV to Aortic CuspAortogram
Non-Coronary Cusp
Figure 6.11C
S1
HBp
HBd
AoVp
AoVd
RV
III
I
II
V1
RAA
A
V
S1
VX
V1-V2 = 510
X
S2
S1-S1 = 580
X-X = 580
A-A = 580
Figure 6.11D
A-A = 580
RV
III
I
II
V1
RAA
A A
“X” Advanced by 20 ms
AoVp
AoVd
HBp
HBd
S1 S1
S2
XXX-X = 560
S1-S1 = 580
Figure 6.11E
Figure 6.11F
A V
AP
AP
HBp
HBd
I
II
V1
RAA
HBm
UNI-2
UNI-1
Aorta pH
AA
A
Far-field AP
Loss AP
Aorta d
Preexcitation Pattern Suggesting Anteroseptal AP
Figure. 6.12A
Figure 6.12B
Catheter below the Right Coronary Cusp
ABL
ABL
HB
HB HBp
HBd
I
II
V1
RAA
HBm
LVp
LVd
UNI-2
UNI-1
CSp
CSd
RV
CSFigure 6.12C
Retrograde Conduction over
Slow Pathway:
(Right Inferior Extension)
Retrograde Conduction over
an Epicarida PS-AP
Figure 6.13A
Figure 6,13B SVT-1
Figure 6.13C SVT-2
Figure 6.13D
CSP
RV
HBd
RAA
I
CSD
HBp
II
V1
SVT-1
Figure 6.13E
RV
CSd
CSp
RAA
V1
II
HBp
HBd
I
SVT-2
HB
CentralFibrousBody
SVT1
SVT2
Figure 6.13F
Figure 6.14A
RV
CSd
CSp
RAA
V1
II
HBp
HBd
I
H
H
100 ms
RV
SUB-CSp
RAA
V1
II
HBp
HBd
I
SUB-CSd
FEM-CSp
FEM-CSd
260 260 260
H H H H H
V V V V’260 260 260
Figure 6.14B
100 ms
RV
SUB-CSp
RAA
V1
II
HBp
HBd
I
SUB-CSd
FEM-CSp
FEM-CSd
H H H H H’
260 260 230
V V V V’260 260 225
260 260 260 250
Figure 6.14C
Figure 6.15A
SmallCardiac
Vein
MiddleCardiacVein
GreatCardiac
Vein
MarshallVein
RA
CoronarySinus
Ostium
LA
LAO Projection
Epicardial PS-AP: Antegrade Conduction
CSE
Coronary SinusMyocardial Extension
(CSE)
PosteriorCoronary
Vein
Early EpicardialVentricular Activation
and CS-E Potential (AP-P)In MCV
Posterior Coronary Vein
Figure 6.15B
LV
LA
GreatCardiacVein
PosteriorCoronary
Vein
SmallCardiac
Vein
MiddleCardiacVein
CSE
LAO Projection
CoronarySinus
Ostium
EarliestAtrial
Activation
LADelay in Reversing
Direction of Activation
Epicardial PSAP: Retrograde Conduction
Figure 6.15C
Atrial-CSE
connections
Ventricular-CSE
connections
Atrium
Ventricle
CSE in MCV
Figure 6.15D
Figure 6.16A
III
V1
RAA
HBp
HBD
CSp
CSD
RV
V3
100 ms
III
V1
RAA
HBp
HBD
CSp
CSD
RV
V3
PL Coronary
Vein
Lateral
LV
Posteroseptal
RV
Anteroseptal
RV
Figure 6.16B
Pace from Lateral Coronary Vein
RAO LAO
RAA
HB
RAA
HB
Figure 6.16C
Pace from Lateral Left Ventricle
RAO LAO
RAA
HB
RAA
HB
Figure 6.16D
Figure 6.17A
I
V1
RAA
HBP
CSP
CSD
RV
II
HBD
MAPP
MAPd
RV Apex PL Coronary Vein AVRT
100 ms
PS-AP or Slow/slow or Fast/slow AVNRT:
CS catheter comes from subclavian or internal jugular vein
Figure 6.17B
Figure 6.17C 100 ms
I
V1RAAHBP
SC-CSP
RV
II
HBD
MAPP
MAPd
UNIdUNIP
SC-CSd
FEM-CSP
FEM-CSd
MAPP
MAPd
UNId
UNIP
I
V1
RAA
HBP
CSP
CSD
RV
II
HBD
Anteroseptal RV Posteroseptal RVPosterolateral
Coronary Vein
Figure 6.17D
Figure 6.18A
RAA
MCVPCV
LV Map
HB
HB
LVMap
CS
RAA
MCV PCV
CS
LAO
RAO
LV Endocardial Mapping -Antegrade AP Conduction
1.2 cm
30
Figure 6.18B
CS
RV Map
RV
HB
CS
RV MapRV
RAA
RAA
LAO
RAO
RV Endocardial Mapping -Antegrade AP Conduction
1.5cm
Courtesy of Dr. Jackman
Figure 6.18C
CSRV
MCV
RV
LAO
RAO
CS Extension – AP Potential (CSE-AP)Deep in Middle Cardiac Vein
RAAHB
RAA
HB
MCV
2.0 cm
Courtesy of Dr. Jackman
Validation of Antegrade CSE-AP Potential
465
520
Figure 6.18D
Validation of Antegrade CSE-AP Potential
495
520
Figure 6.18E
LV
LA
GreatCardiacVein
PosteriorCoronary
Vein
SmallCardiacVein
MiddleCardiacVein
CSE
LAO Projection
CoronarySinus
Ostium
EarliestAtrialActiv
LA
RetrogradeConduction
Delay in Reversing Direction of Activation
Figure 6.19A
35
A1
495
520
Figure 6.19B
440
490
520
Figure 6.19C
520
Figure 6.19D
2 mm
2 mm
Figure 6.20A
LAO RAO
Ideal Ablation
Site in MCV
Figure 6.20B
Figure 6.20C LAO
PL branch
of RCA
Ablation Site
Deep MCV
Floor of CS
LAO
Figure 6.20D
Figure 6.21A
Figure 6.21B
LV
RAA
V1
II
HBp
HBd
CSd
CSp
I
MAPP
MAPD
UNI-1
UNI-2
100 ms
Figure 6.21C
LV
RAAV1
II
HBp
HBd
CSd
CSp
I
MAPP
MAPD
UniD
UniP
100 ms
RV
RAA
V1
II
HBp
HBd
CSd
CSp
I
CryoP
Cryod
UNI-1
UNI-2
Figure 6.21D
MCV
Figure 6.22A
Figure 6.22B
Small Cardiac
Vein