Post-transplant atrial tachyarrhythmias: Epidemiology, mechanisms, outcomes, and management across solid organs

Figure 3 Representative original case from our center showing electroanatomical mapping and radiofrequency catheter ablation in a patient with atrial fibrillation following orthotopic heart transplantation, demonstrating recipient-donor atrial conduction across the left inferior pulmonary vein region. A: Posterior view of the left atrium obtained using the CARTO 3 system (Biosense Webster, CA, United States). The bipolar voltage map uses a 0.10-0.50 mV display scale and demonstrates electrical continuity between recipient and donor atrial tissue in the area adjacent to the left inferior pulmonary vein, suggesting a recipient-graft atrioatrial conduction pathway and posterior wall scar that served as a trigger for atrial fibrillation. This finding guided the ablation strategy, which targeted isolation of the left pulmonary veins and posterior left atrial wall; B: Final electroanatomical map confirming complete electrical isolation of the posterior left atrial wall and left pulmonary veins following ablation, with no residual conduction across the previously identified recipient-donor atrial connection; C: Three-dimensional reconstruction showing radiofrequency ablation lesions placed to achieve circumferential isolation of the left pulmonary veins and posterior wall.