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.