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No fluoroscopy for cavotricuspid isthmus-dependent right atrial flutter ablation
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No fluoroscopy for cavotricuspid isthmus-dependent right atrial flutter ablation Marta Pachón, MD, Miguel A. Arias, MD, PhD, Eduardo Castellanos, MD, PhD, Alberto Puchol, MD From the Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain. A 43-year-old man was referred for catheter ablation of persistent class IC antiarrhythmic drug-related atrial flutter. The patient had a long history of symptomatic paroxysmal lone atrial fibrillation refractory to several drugs and has been under good control with atenolol and flecainide treatment. Initially, a cutaneous patch was used as a positional reference in order to advance the catheters throughout the venous system via the right femoral vein to the right atrium completely guided by a nonfluoroscopic navigation system (EnSite-NavX, St. Jude Medical, St. Paul, MN, USA) (Figure 1, panel A). Nondetailed geometric reconstruction of the right atrium was obtained to facilitate positioning of a 7Fr steerable quadripolar catheter inside the coronary sinus. KEYWORDS Atrial flutter; Navigation system; Catheter ablation (Heart Rhythm 2009;6:433– 434) Address reprint requests and correspondence: Dr. Miguel A. Arias, Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Avda. Barber 30, Planta Semisótano, 45004, Toledo, Spain. E-mail address: [email protected].
This catheter served as the positional reference for the remainder of the procedure. Three-dimensional geometric reconstruction of the right atrium including the His-bundle area and coronary sinus (Figure 1, panels B and C) was obtained by sweeping the catheters throughout the cardiac chambers, defining endocardial boundaries. A duodecapolar catheter was placed around the tricuspid annulus, and an 8-mm-tip ablation catheter (Safire Bi-directional Ablation Catheter, St. Jude Medical) was placed at the cavotricuspid isthmus region. Entrainment maneuvers were performed, and isthmus dependence of the tachycardia was confirmed. Radiofrequency current was delivered in temperature-controlled mode during point-by-point ablation starting at the tricuspid annulus with power output 60 W, preselected temperature 60°C, and 120-second preselected pulse duration. Catheter tip position was monitored exclusively by nonfluoroscopic electroanatomic navigation system. Bidirectional isthmus block was achieved. No complications occurred, and no fluoroscopy was used during the entire procedure. The patient has not experienced recurrence of atrial flutter
Figure 1
1547-5271/$ -see front matter © 2009 Heart Rhythm Society. All rights reserved.
doi:10.1016/j.hrthm.2008.07.019
434 during follow-up and has continued with atenolol and flecainide treatment. The present case demonstrates that use of a nonfluoroscopic navigation system during catheter ablation of isthmus-dependent common-type atrial flutter can be performed without fluoroscopy. However, the safety and security of
Heart Rhythm, Vol 6, No 3, March 2009 this approach must be validated from prospective and randomized studies.
Acknowledgment We thank Ricardo Poyato (St. Jude Medical, Spain) for excellent technical assistance.
No fluoroscopy for cavotricuspid isthmus-dependent right atrial flutter ablation Marta Pachón, MD, Miguel A. Arias, MD, PhD, Eduardo Castellanos, MD, PhD, Alberto Puchol, MD From the Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain. A 43-year-old man was referred for catheter ablation of persistent class IC antiarrhythmic drug-related atrial flutter. The patient had a long history of symptomatic paroxysmal lone atrial fibrillation refractory to several drugs and has been under good control with atenolol and flecainide treatment. Initially, a cutaneous patch was used as a positional reference in order to advance the catheters throughout the venous system via the right femoral vein to the right atrium completely guided by a nonfluoroscopic navigation system (EnSite-NavX, St. Jude Medical, St. Paul, MN, USA) (Figure 1, panel A). Nondetailed geometric reconstruction of the right atrium was obtained to facilitate positioning of a 7Fr steerable quadripolar catheter inside the coronary sinus. KEYWORDS Atrial flutter; Navigation system; Catheter ablation (Heart Rhythm 2009;6:433– 434) Address reprint requests and correspondence: Dr. Miguel A. Arias, Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Avda. Barber 30, Planta Semisótano, 45004, Toledo, Spain. E-mail address: [email protected].
This catheter served as the positional reference for the remainder of the procedure. Three-dimensional geometric reconstruction of the right atrium including the His-bundle area and coronary sinus (Figure 1, panels B and C) was obtained by sweeping the catheters throughout the cardiac chambers, defining endocardial boundaries. A duodecapolar catheter was placed around the tricuspid annulus, and an 8-mm-tip ablation catheter (Safire Bi-directional Ablation Catheter, St. Jude Medical) was placed at the cavotricuspid isthmus region. Entrainment maneuvers were performed, and isthmus dependence of the tachycardia was confirmed. Radiofrequency current was delivered in temperature-controlled mode during point-by-point ablation starting at the tricuspid annulus with power output 60 W, preselected temperature 60°C, and 120-second preselected pulse duration. Catheter tip position was monitored exclusively by nonfluoroscopic electroanatomic navigation system. Bidirectional isthmus block was achieved. No complications occurred, and no fluoroscopy was used during the entire procedure. The patient has not experienced recurrence of atrial flutter
Figure 1
1547-5271/$ -see front matter © 2009 Heart Rhythm Society. All rights reserved.
doi:10.1016/j.hrthm.2008.07.019
434 during follow-up and has continued with atenolol and flecainide treatment. The present case demonstrates that use of a nonfluoroscopic navigation system during catheter ablation of isthmus-dependent common-type atrial flutter can be performed without fluoroscopy. However, the safety and security of
Heart Rhythm, Vol 6, No 3, March 2009 this approach must be validated from prospective and randomized studies.
Acknowledgment We thank Ricardo Poyato (St. Jude Medical, Spain) for excellent technical assistance.