case_images: PMC11770597_01
case_images: Voltage map viewed from the posteroanterior view (A) and local activation time isochronal mapping of the right atrium and superior vena cava constructed by EnSite  viewed from the right anterior oblique view (B).
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case_images: We then empirically added LA posterior wall isolation with roof and bottom lines (Figure 1A). RA (Figure 2C) without electrical endocardial conduction, which spread in a centrifugal pattern from this breakout site (Figure 1B), leading to a diagnosis of EC between the SVC and RA. Radiofrequency energy was delivered to EC at a maximum power of 25 W (Figure 3).
case_images: Intra-cardiac electrograms of the spontaneous activities from a high-density mapping catheter placed in the superior vena cava that initiated atrial fibrillation (A), the earlier fragmentated potential with fragmentated prepotential recorded from the tip of the ablation catheter than that from the circular mapping catheter (B), the earliest activation site of the right atrium during pacing by an ablation catheter on this site (C), the abolishment of the remaining potentials inside the superior vena cava isolation line (complete entrance block) (D), and the non-conduction to the atrium pacing from the circular mapping catheter inside the superior vena cava isolation line (complete exit block) (E). The white square picture in (B) indicates the enlarged potential recorded from the tip of the ablation catheter.
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case_images: The bolus injections of isoproterenol (3 mug) induced AF, following spontaneous activities from an HDMC positioned in the SVC (white arrow in Figure 2A). Abbott) positioned in the SVC were observed (Figure 2B). Although the SVC isolation line was mapped precisely using CMC, the line seemed complete. We then confirmed the earlier potential with a fragmented prepotential of the ablation catheter compared with that of the CMC (Figure 2B). RA (Figure 2C) without electrical endocardial conduction, which spread in a centrifugal pattern from this breakout site (Figure 1B), leading to a diagnosis of EC between the SVC and RA. Radiofrequency energy was delivered to EC at a maximum power of 25 W (Figure 3). The remaining potentials in the SVC steadily abolished (complete entrance block) (Figure 2D). Pacing from the CMC at an output of 10 V inside the SVC isolation line did not establish conduction to the atrium (complete exit block) (Figure 2E).
case_images: Frontal fluoroscopic images during delivering of radiofrequency energy to epicardial connection.
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case_images: PMC11770597_01_ytaf016f3.jpg
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case_images: RA (Figure 2C) without electrical endocardial conduction, which spread in a centrifugal pattern from this breakout site (Figure 1B), leading to a diagnosis of EC between the SVC and RA. Radiofrequency energy was delivered to EC at a maximum power of 25 W (Figure 3).