Figure Legends
Figure 1. Atrial fibrillation ablation with EpicorTMhigh-intensity focused ultrasound aims to create a box isolation around the four pulmonary veins. Herefore, an ultraclinch device is placed around the pulmonary veins, and closed in front of the right superior pulmonary vein (A). Accordingly, the voltage map of the left atrium reveals a line of low-voltage zones around the pulmonary veins that represent the EpicorTM ablation line (A+B). However, there are multiple gaps along the line, particularly among the anterior segments of the right pulmonary vein (A, RAO projection), and among the posterior wall (B, PA projection). Abbreviations: LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; PA = posterior anterior; RAO = right anterior oblique; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein.
Figure 2. Activation (A) and coherent mapping (B) of the left atrium demonstrate a focal activation pattern of the atrial tachycardia. The tachycardia originates from a gap in the EpicorTMablation line (*), which is located right at the transition to the left atrial appendage (colored in blue). In the coherent map, zones of slow or no conduction are colored in brown. The corresponding intracardial signals at the earliest activation site are shown in the bipolar derivative MAP 1-2 and the unipolar derivative MAP 1, respectively. Abbreviations: LAA = left atrial appendage; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein.
Figure 3. The EpicorTM line was completed by ablation points at the posterior wall and the anterior segments of the right PV. After ablation, the voltage map of the left atrium confirms the successful isolation of all pulmonary veins and the posterior wall (A, RAO projection; B, PA projection). Abbreviations: LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; PA = posterior anterior; RAO = right anterior oblique; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein.