Aims : We created a new catheter ablation method with continuous pacing from the tip of the ablation catheter（CP ablation）to improve the quality of pulmonary vein isolation（PVI）for atrial fibrillation and analyzed the efficacy and safety of this method. Methods : In 16 patients in whom PVI was performed for paroxysmal atrial fibrillation（8 with a CP ablation, 4 men and 4 women, average age 68.9±9.9y, and 8 with a linear ablation, 6 men and 2 women, average age 58.5±9.9y）the duration of the power delivery time, total fluoroscopic time, total procedure time, and appearance of reconnections as well as dormant conduction of the left atrium-PVs after PVI were investigated. Results : The total power delivery time（CP ablation vs. linear ablation, 23.8±4.3min vs. 29.5±4.6min, respectively, p＝0.03）and total fluoroscopic time（CP ablation vs. linear ablation, 27.0±6.0min vs. 36.0±6.0min, respectively, p＝0.05）were shorter in the CP ablation group than in the linear ablation group. There were no significant differences between the groups in the total procedure time（CP ablation vs. linear ablation, 123.8±9.0min vs. 113.9±13.5min, respectively, p＝0.23）, the appearance of dormant conduction（CP ablation vs. linear ablation, 4 of 8 vs. 2 of 8, respectively, p＝0.32）and reconnections（CP ablation vs. linear ablation, 4 of 8 vs. 2 of 8, respectively, p＝0.32）after PVI. Conclusion : CP ablation was useful for reducing the total power delivery time and total fluoroscopic time of PVI.

The EnSite system has been widely applied to catheter ablation procedures in Japan. Using EnSite Precision^TM Software Version2 /Auto Map Module（Ver2）offline analyzer, we retrospectively created 3D images during tachycardia using auto map, fractionation map and score map for individual cases and identified the features of these functions added by Ver2. The auto map, depending on its settings, could be made into a high-density map compared with the manually prepared activation map. However, it was difficult to identify the tachycardia circuit at both the atrial and ventricular electrogram recording sites. The fractionation map was useful to determine the optimal ablation site by transferring the fractionated potentials to activation map. The score map, showing the location information of pace mapping score, was considered useful in ablation for premature ventricular contraction. But locational adjustment was required when creating the map. Even though the EnSite system has become more useful as a result of advanced mapping modules, it was necessary to grasp their features before applying this system.

An excimer laser sheath has recently been used to cardiac implantable electronic devices（CIEDs）leads. We report the case of lead extraction using this system in a 72-year-old man who had developed a pacemaker infection with pain and swelling in the pacemaker pocket. He had undergone pacemaker implantation（DDD mode）10 years previously, and 16 months had passed since generator replacement. The right atrium（RA）lead had been inserted via the right subclavian puncture and the right ventricular（RV）lead via cut-down of the right cephalic vein. The RA lead was extracted without complication. During extraction of the RV lead, we easily excised the adhesions and smoothly advanced the sheath over the lead. As the procedure continued, however, the tip of the sheath reached the superior vena cava, where we met resistance and could hardly advance the sheath, eventually no longer being able to push it forward over the RA. The tip of the lead had already detached from the RV, and the lead itself was free from any adhesions. Although it was impossible to pull the lead backward into the sheath, we finally removed the entire system. Tissue from the compressed vein was evident around part of the lead and apparently had caused locking of the lead and sheath. This unfavorable situation deserves careful attention when attempting to extract of a lead using an excimer laser sheath via the cephalic vein.