Ask Dr. Z

Aided by CARTO 3 mapping system & ICE wide area circumferential ablation was performed around antrum of both LT &RT PVs(WACAs) Lesions were delivered @ 45W for F' goal 400-450 & 500-550 on posterior & anterior walls, respectively. LT vein isolation was achieved on first pass. Breakthrough were noted in RT PVs, which required reinforcement lesions along WACA & lesions in RT carina area, forming a carinal line. post-ablation voltage map also confirmed presence of ablation related scar along wide area antral lesion set without any evidence of residual viable myocardial tissue. Adenosine showed no evidence of inducible reconnection Burst pacing from CS resulted in induction of an SVT that quickly degenerated into AFIB, which later self-terminated Given abnormal PW voltage & inducible AF, posterior wall isolation was pursued. Ablation lesions were incorpoated in posterior box with roof line & floor line connecting posterior aspects of LT & RT WACA lesions around pulmonary veins.Additional lesions were applied in posterior box @site epicardial breakthroug