Pranav Bhagirath

84 Chapter 4 Table 3. Gap distribution among the pulmonary veins. RSPV RIPV LSPV LIPV Patient 1 3 2 1 1 Patient 2 1 2 1 0 Patient 3 1 2 0 1 Patient 4 2 2 2 1 Patient 7 1 2 1 1 RSPV indicates right superior pulmonary vein; RIPV, right inferior pulmonary vein; LSPV, left superior pulmonary vein; LIPV, left inferior pulmonary vein. Gaps on the scar-map were most frequently observed in the RIPV. The LIPV showed the lowest number of gaps on the scar-map. Redo procedure The site of ablation during the redo procedure EAM was related to the gaps identified on the scar-map ( figure 4 ). In addition, all scar-maps demonstrated gaps that correlated to electrically dormant and therefore unablated areas on the EAM. The posterior part of the left pulmonary veins was a predilection spot for such sites. LSPV LIPV RSPV RIPV EAM – Redo procedure Viable Scar Scarmap Figure 4. Example of a scar-map guided ablation. The left panel demonstrates a scar-map and the right panel shows the redo-procedure EAM of the corresponding patient. There is a good visual correlation between the scar-map sites with gaps (blue arrows) and the redo-procedure ablation sites (orange arrows). Ablation outcome The redo ablation was successful in two paroxysmal AF and one persistent AF patient. One of the patients with persistent AF underwent a third procedure aimed at performing substrate modification. The other patient with persistent AF underwent His bundle ablation with implantation of a permanent pacemaker.