The discovery of the role of the pulmonary veins (PVs) in atrial fibrillation (AF) has facilitated us to perform an anatomy-based ablation, “PV isolation”. Although several new mapping technologies have been developed, activation mapping during ongoing AF is still challenging. To improve the efficacy of AF ablation, therefore, we attempted to find the second “hot spot”. The superior vena cava, ligament of Marshall, coronary sinus and posterior LA have been reported as second critical areas for AF ablation. However, there remain patients who are refractory to catheter ablation targeting all of those above areas.
Credits: Yoshihide Takahashi MD