How to do circular mapping catheter-guided pulmonary vein antrum isolation: The Cleveland Clinic approach

Abstract

c o o F u d a p ntroduction trial fibrillation (AF) is one of the 20th-century epidemics. ver the past 2 decades, significant advances have been ade in the treatment of AF, the last being percutaneous blation. Haissaguerre et al showed that AF triggers often riginate from the thoracic veins. The goal of present-day F ablation is to electrically “disconnect” the pulmonary eins (PVs) from the rest of the left atrium (LA) by ablating round the origin of the veins. At present, at least two echniques are used for AF ablation. The first is an anatomic pproach guided by nonfluoroscopic navigation systems e.g., CARTO (Biosense Webster, Diamond Bar, CA), avX (St Jude Medical, St Paul, MN), LocaLisa Medtronic, Minneapolis, MN)), in which radiofrequency RF) ablations are delivered circumferentially outside the V ostia with a variety of additional ablation lesions withut necessarily demonstrating complete electrical isolaion. The second approach, which is performed at the leveland Clinic, requires electrical isolation of the entire V antra as the endpoint. This is achieved by a circular apping technique with the use of intracardiac echocardigraphy for guidance (Figure 1).