Notable Pacemaker Shift in the Sinoatrial Node After Administration of Isoproterenol.

Abstract

A 63-year-old woman underwent a redo catheter ablation for recurrent atrial fibrillation (AF) after an initial cryoballoon ablation. After confirming the electrical isolation of 4 pulmonary veins, empiric superior vena cava (SVC) isolation was performed without documenting AF triggers. A 20-pole PentaRay NAV catheter (Biosense Webster, Diamond Bar, CA) was used to create an activation map during sinus rhythm to identify the anatomic location of the sinoatrial node (SAN). The earliest atrial activation site (EAS) at baseline was the basal lateral wall of the right atrial appendage (Fig. 1A).