Data Supplement

Files in this Data Supplement:

• Movie IA - (Quicktime movie) (7 MB). Two-dimensional transesophageal echocardiography (TEE): mid-esophageal mitral commissural view of the left atrium, ligament of Marshall, left superior pulmonary vein, left atrial appendage and mitral valve demonstrating the ablation catheter tip near the ligament of Marshall. LOM = ligament of Marshall; CATH = ablation catheter; LSPV = left superior pulmonary vein; LAA = left atrial appendage; MV = mitral valve. Recommended application for optimal viewing of this movie file is QuickTimeŽ.
• Movie IB - (Quicktime movie) (10 MB). Intracardiac echocardiography (ICE): this two-dimensional view of the left atrium demonstrates limitations of ICE imaging; there is significant movement of the 2D imaging plane relative to the heart during the cardiac cycle causing the left inferior pulmonary vein to move in and out of the plane of view. LA = left atrium; RA = right atrium; LIPV = left inferior pulmonary vein; abbreviations otherwise as in movie 1A. Recommended application for optimal viewing of this movie file is QuickTimeŽ.
• Movie IIA - (Quicktime movie) (9.6 MB). Real-time three-dimensional transesophageal echocardiography (RT-3D-TEE): This movie demonstrates how RT-3D-TEE clearly defines the topographic relationship between the ligament of Marshall, the anterior region of the left pulmonary vein antrum and the left atrial appendage, throughout the entire cardiac cycle. The open-irrigation ablation catheter is positioned on the lower part of the ligament of Marshall near the left inferior pulmonary vein antrum. Micro-bubble artifacts are seen emanating from the tip of the ablation catheter due to normal saline open irrigation (17-25 ml/min) for cooling during RF energy delivery. LOM = ligament of Marshall; CATH = ablation catheter; LSPV = left superior pulmonary vein; LAA = left atrial appendage; MV = mitral valve. Recommended application for optimal viewing of this movie file is QuickTimeŽ.
• Movie IIB - (Quicktime movie) (10 MB). Real-time three-dimensional transesophageal echocardiography (RT-3D-TEE): Movie 2B and 2C show ablation catheter at two distinct positions along the ligament of Marshall during ablation energy delivery. Movie 2B shows the ablation catheter tip at the middle portion of the ligament of Marshall whereas movie 2C shows the catheter tip positioned at the superior and anterior region of the ligament of Marshall. Note that in movie 2C the catheter tip not only moves up and down with the cardiac cycle, but also moves from the appendage side to the vein antrum side of the ligament of Marshall during respiration consistent with tissue contact. Open irrigation of the ablation catheter is evident as microbubbles emanating from the catheter tip as in movie 2A. LOM = ligament of Marshall; CATH = ablation catheter; LSPV = left superior pulmonary vein; LAA = left atrial appendage; MV = mitral valve. Recommended application for optimal viewing of this movie file is QuickTimeŽ.
• Movie IIC - (Quicktime movie) (8 MB). Real-time three-dimensional transesophageal echocardiography (RT-3D-TEE): Movie 2B and 2C show ablation catheter at two distinct positions along the ligament of Marshall during ablation energy delivery. Movie 2B shows the ablation catheter tip at the middle portion of the ligament of Marshall whereas movie 2C shows the catheter tip positioned at the superior and anterior region of the ligament of Marshall. Note that in movie 2C the catheter tip not only moves up and down with the cardiac cycle, but also moves from the appendage side to the vein antrum side of the ligament of Marshall during respiration consistent with tissue contact. Open irrigation of the ablation catheter is evident as microbubbles emanating from the catheter tip as in movie 2A. LOM = ligament of Marshall; CATH = ablation catheter; LSPV = left superior pulmonary vein; LAA = left atrial appendage; MV = mitral valve. Recommended application for optimal viewing of this movie file is QuickTimeŽ.