2. Intracardiac Recordings Rapid activities inside the LSPV

3. First Step: Pulmonary Vein Isolation Slowing of LSPV activities AF procedural termination during LPV isolation

4. Inducible Clinically Documented AFL-I (CL=237 msec) Positive concordance of F wave in the precordial leads: Negative in aVL Positive in inferior leads and V1 Flat in lead I

6. Inducible Clinically Documented AFL-2 (CL=218 msec) Negative in aVL Almost flat in V2-V6 Positive in inferior leads and lead V1 Negative in lead I

8. Summary of F wave Morphology after PV Isolation Marchlinski group 2007, JCE - + -/+ + + + V2-V6 + - + + + + V1 - + - + + + II,III,aVF +/- + + - - + aVL Flat or - +/- + Flat or - Flat or +/- + or +/- I Counter-C RA AFL Clockwise RA AFL ClockwiseMitral Flutter Counter-C Mitral Flutter LPV AT RPV AT Positive concordance in precordial leads or negative in aVL indicated LA tachycardias

9. Activation Map of the First AFL LPV Reentry LSPV LIPV RSPV RIPV MV Opposite activation of anterior wall and posterior wall of LA

10. Immediately after Roof Line ablation: Convert to 2nd AFL: Mitral AFL LSPV LIPV LSPV RSPV RIPV MV Same direction of activation (low to high) in the anterior and posterior wall of LA LSPV RSPV MV Posterior wall

11. Rapid activities in the RA LSPV was silent AFL Converted to AF and Terminated during Mitral Line Ablation AF terminated AFL AF

13. Spontaneous Burst Triggers after AFL Termination Positive in lead II and Biphasic in lead V1

14. Reverse of atrial potential from RSPV recording Intracardiac recordings RA Catheter in the High RA Intracardiac recording RSPV RA Similar CS sequence of sinus beat and triggers Fluoroscopy : RAO view RA catheter

16. Advance the High RA Catheter into SVC RSPV SVC High-to-low sequence during APCs Intracardiac recording Fluoroscopy : RAO view RA catheter Right atrium SVC

20. Isolation of Superior Vena Cava Confirm the SAN origin first by RA activation mapping RA free wall LA LSPV RSPV Confirm the orifice of SVC by angiography