Second ablation
The patient was referred for surgery. After the left-side pericardium opened, LAA with multiple lobes was seen. Then, mapping was performed on the epicardial surface of LAA, and demonstrated that the earliest activation (−120 msec) during tachycardia was found at the apex of upper lobe. LAA angiography demonstrated that this site was adjacent to the endocardial site of earliest activation (Figure 3). At this epicardial site, radiofrequency application using a FlexAbility irrigated ablation catheter (St Jude Medical, St Paul, MN, USA) eliminated the tachycardia within 5 seconds of onset of energy (a temperature of 43°C and power settings of 30 W). After adequate power achieved, the AT could not be induced.