Radiofrequency Catheter Ablation of on-going Persistent Atrial Fibrillation Using a Noncontact Mapping System

We describe a 70-year-old man with persistent atrial fibrillation (AF) lasting for 3 months who underwent radiofrequency catheter ablation (RFCA) during on-going AF under navigation using a noncontact mapping system (NCM). The AF was converted by the RFCA first to a secondary atrial tachycardia (AT) consisting of common atrial flutter during the left atrial (LA) roof line creation, second to a secondary AT consisting of a focal AT originating from the right superior pulmonary vein, third to a secondary AT which rotated around the LA appendage, and finally to an AT consisting of a peri-mitral flutter after the completion of the circumferential pulmonary vein ablation and LA roof line creation. All the ATs were quickly identified by the dynamic activation map constructed with the NCM and subsequent detailed analysis of the virtual unipolar electrograms, and were eliminated by additional RFCA for each AT mechanism identified. The patient has had no recurrence during 10 months of follow-up without taking any antiarrhythmic agents.