Mackenzie Willborn

Mitral AFL utilizing Bachmanns Bundle fibers as an epicardial connection - let’s get into it! Upon ablating an anterior mitral line, we extend our CL by 65ms. Further LA ablation proves no change to TCL - We ultimately terminate AFL at the septal RA/SVC junction by contact alone!

LSPV gap and slow wave speed correlation? LSPV gap rapidly identified with Omnipolar Technology (OT) and isolated with #TactiCathSE. The wave speed map was analyzed and the slow zone (red-yellow) directly correlated with the remaining connection. @AbbottCardio #AbbottAF #EPeeps

Timing in AF? Omnipolar Technology (OT) shows local wavefront activation independent of LAT. #OT and #HDGrid rapidly identified the leak in our right WACA. 🎯 look at that independent firing following isolation with #TactiCathSE 👀 #EPeeps #AbbottAF @AbbottCardio @RajeevJoshi400

First VoXel AF case for this #EnSiteX user. The inherently linear geometry definitely assisted with navigation throughout this branchy chamber. 🧲 Look at that LSPV takeoff! 👀 #AbbottAF @AbbottCardio @mackenziew_EP

Make your typical flutters eXciting with Omnipolar Technology (OT)! OT rapidly identified the narrow isthmus allowing this CTI-dependent flutter to persist. By using localized signal properties, OT vectors are independent of LAT annotation! #OnlyWithOT #EnSiteX #EPeeps

With #EnSiteX and #OT we were able to see the muscle sleeve entering the LIPV — traditional bipolar EGMs showed a much broader connection. We’re seeing vein connections differently #OnlyWithOT. #EPeeps #TrueEGMs #HDGrid @AbbottCardio @OneBurnJuan @EPDenault

The open window mapping technique allowed us to create a very comprehensive map of this LLAP while in NSR with pre-excitation! I love being able to achieve this level of understanding of a pts arrhythmia while keeping them in comfortable sinus rhythm 🤗 @AbbottCardio #EPeeps

By self-referencing sharp signals on #HDGrid, #LiveView allowed for beat-by-beat timing localization of the leak into the LIPV despite being in AF. Following white (early) with #TactiCathSE allowed for rapid isolation of the LIPV. @mackenziew_EP @AbbottCardio #JustGridIt #EPeeps

Color propagation for this interesting case 😊

Mitral AFL utilizing Bachmanns Bundle fibers as an epicardial connection - let’s get into it! Upon ablating an anterior mitral line, we extend our CL by 65ms. Further LA ablation proves no change to TCL - We ultimately terminate AFL at the septal RA/SVC junction by contact alone!

@AnandShah_MD This crossed my mind as well! Especially due to the proximity of the RA lesions to the MA line. Maybe the RA lesions achieved the transmurality needed to affect a BB connection? Could it be both?

@mackenziew_EP Great case! I have seen a similar case and outcome where block across MA line was dependent on ablation in RA at high septum/limbus opposite the MA line- I thought it was 2/2 inability to get transmural there, not BB…

@SuchitMajumder @mattaustein The pt had an anterior line done in a previously, we noticed leak through it on the initial map. After touching that up & remapping only the LA, we were missing about 10% CL (now wondering about epicardial bridge) and then bump terminating on the RA made us think Bachmanns

@mackenziew_EP @mattaustein Why anterior line was chosen? How did you localise the bachman is culprit

@mattaustein Yes this could be the case! Unfortunately we did not remap both atria following the CL increase! We moved to the RA accidentally after losing our transseptal. Hence the bump term - location of the bump term and initial RA activation clued us in to Bachmanns involvement!

@mackenziew_EP Once TCL increased, went from MA flutter to Bi-Atrial Flutter… otherwise RA - SVC ablation wouldn’t have done anything… right?

@svTri24 @Segarspr Yes I wish we had done this, I would be curious to know how we affected the intrinsic conduction!

@mackenziew_EP @Segarspr Excellent case and Beautiful map! I wonder what the activation is like in a post RF sinus map!

Ablation at our termination site in the RA renders our Mitral AFL non-inducible 🤩 What an interesting case!

@XavierR_EP @AbbottCardio Thanks Xavier 🤗

@mackenziew_EP @AbbottCardio Awesome looking prop map Mack!

Right sided scar-related AFL mapped with #HDGrid 🤩 Surface EKG was consistent with Typical AFL, but this high density map gave us a clear image of what was truly propagating our patients reentrant circuit! @AbbottCardio

@sheilapressley7 @AbbottCardio Thanks so much! 😊

@mackenziew_EP @AbbottCardio Nice!

@palen_matt @AbbottCardio Thank you! 😊

@mackenziew_EP @AbbottCardio Way to go!

Site of termination!

Termination site 😍

Critical isthmus of another Atypical Flutter looking GREAT with the help of some of my favorite Ensite Precision features - Sparkle map, a color contour adjustment, and Low V-ID adjustment to 0.70 mV. Beautiful map made with #HDGrid by @BurnThatSpot !!