{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T22:21:30Z","timestamp":1790720490520,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High\u2010density three\u2010dimensional (3D) mapping in the Triangle of Koch during sinus rhythm (SR) has demonstrated low amplitude, late activating, multi\u2010component signals suggestive of the AV nodal (AVN) right inferior extension (RIE). Ablation at the site of these signals has been successful for the treatment of typical AV nodal reentrant tachycardia (AVNRT). The leftward inferior extension (LIE) of the AVN has been proposed as a participatory limb in AVNRT and described in the inferoseptal region of the left atrium (LA). We present the use of Ripple mapping of the LA in sinus rhythm to identify low amplitude, late\u2010activating multi\u2010component atrial electrograms similar to those seen at the RIE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>Patients undergoing first\u2010time ablation for paroxysmal atrial fibrillation at one institution over a 1\u2010year period were included. High\u2010density mapping of the entire LA was performed in SR using multi\u2010spline mapping catheter &amp; CARTO\u20103 (Biosense Webster Inc.). Left atrial activation was recorded and displayed using CARTO Ripple mapping, and local electrograms manually reviewed in areas with delayed and multi\u2010component activation. Thirty\u2010two patients underwent LA mapping; in 26 patients, low amplitude, late activating, multi\u2010component electrograms were recorded in the inferoseptal region with discrete, late far\u2010field signal similar in profile to previously described RIE slow pathway potential. Of the six remaining cases, the annotated LA activation was posterolateral in five and in the superior septum in one case. The mapping technique was also utilized in a case of \u201cslow\/fast\u201d typical AVNRT in which ablation at the typical slow pathway site in the Triangle of Koch and within the coronary sinus did not elicit junctional response and tachycardia remained inducible. Mapping the LA septum in SR was performed. Ablation at the inferoseptal site with late\u2010activating, multi\u2010component electrogram resulted in junctional beats with non\u2010inducibility of tachycardia without recurrence through 31 months post\u2010procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Using high\u2010density 3D mapping in SR, multi\u2010component far\u2010field electrograms can be identified at sites of late LA activation. In one case of AVNRT requiring LA ablation, ablation at this site was successful. Further study may provide additional information regarding the relationship of these signals and the LIE of the AVN.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70293","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T04:20:50Z","timestamp":1773116450000},"page":"925-929","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Characterization of AV Nodal Left Inferior Extension by Use of High\u2010Density Mapping and Voltage\u2010Time Relationship"],"prefix":"10.1111","volume":"37","author":[{"given":"June K.","family":"Pickett","sequence":"first","affiliation":[{"name":"Department of Medicine (Division of Cardiology) Baylor College of Medicine Houston Texas USA"},{"name":"Texas Heart Institute Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5263-6535","authenticated-orcid":false,"given":"Joshua R.","family":"Hirsch","sequence":"additional","affiliation":[{"name":"Department of Medicine (Division of Cardiology) Baylor College of Medicine Houston Texas USA"},{"name":"Texas Heart Institute Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6702-3405","authenticated-orcid":false,"given":"Michael Charles C.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Medicine (Division of Cardiology) Baylor College of Medicine Houston Texas USA"},{"name":"Texas Heart Institute Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdi","family":"Rasekh","sequence":"additional","affiliation":[{"name":"Department of Medicine (Division of Cardiology) Baylor College of Medicine Houston Texas USA"},{"name":"Texas Heart Institute Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna E.","family":"Molina\u2010Razavi","sequence":"additional","affiliation":[{"name":"Department of Medicine (Division of Cardiology) Baylor College of Medicine Houston Texas USA"},{"name":"Texas Heart Institute Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7176-5586","authenticated-orcid":false,"given":"Mehdi","family":"Razavi","sequence":"additional","affiliation":[{"name":"Department of Medicine (Division of Cardiology) Baylor College of Medicine Houston Texas USA"},{"name":"Texas Heart Institute Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9688-1604","authenticated-orcid":false,"given":"Mihail G.","family":"Chelu","sequence":"additional","affiliation":[{"name":"Department of Medicine (Division of Cardiology) Baylor College of Medicine Houston Texas USA"},{"name":"Texas Heart Institute Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2813-7995","authenticated-orcid":false,"given":"Payam","family":"Safavi\u2010Naeini","sequence":"additional","affiliation":[{"name":"Texas Heart Institute Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3478-5905","authenticated-orcid":false,"given":"Mohammad","family":"Saeed","sequence":"additional","affiliation":[{"name":"Department of Medicine (Division of Cardiology) Baylor College of Medicine Houston Texas USA"},{"name":"Texas Heart Institute Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199207303270504\/ASSET\/D4F2CBF8-4786-45E5-A0DB-89C1E4BFEA56\/ASSETS\/IMAGES\/LARGE\/NEJM199207303270504_F6.JPG"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/S10840-020-00841-8"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/JCE.14481"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.HROO.2021.01.007"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.HRTHM.2009.08.038"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.97.2.188"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.15420\/AER.2021.43"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2025.04.009"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.120.008732"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.018443"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/J.1540-8167.2006.00598.X"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.118.006631"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/EUROPACE\/EUAA031"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.IPEJ.2020.10.004"},{"key":"e_1_2_9_16_1","volume-title":"Josephson's 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