Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review

Figure 5

(a) High-density mapping performed with the 3D CARTO 3 V7 system and bipolar PentaRay™ NAV Catheter (Biosense Webster), to research, during AF, rotational (Ras), and focal activities (FA). The green squares indicate the FAs, while the blue squares indicate the RAs. A repetitive RA is clearly visible between the posterior and the inferior wall of the left atrium, involving a large area (calculated at 4.2 cm²), which is more compatible with a real rotor (macroreentrant driver rather than a microreentrant one). Positioning the PentaRay in the same spot at different times (white circles with a distance of ≤1 mm), we reproduced the left atrium identically. The ablation was directed to the treatment of the RAs. In (b), after RF application on the entire rotor seat area, the left atrium mapping during fibrillation demonstrates its complete disappearance (FIRM approach). The procedure was completed with PVI and synchronized electrical cardioversion. No AF recurrence at 12-month follow-up.

(a)

(b)