Long-standing persistent atrial fibrillation ablation without use of fluoroscopy in a patient with cor triatriatum Saumil R. Shah, MD, Guru P. Mohanty,

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Date of download: 5/29/2016 Copyright © The American College of Cardiology. All rights reserved. From: Emerging Applications for Transseptal Left Heart.

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Long-standing persistent atrial fibrillation ablation without use of fluoroscopy in a patient with cor triatriatum Saumil R. Shah, MD, Guru P. Mohanty, MD, David M. Gilligan, MD, FHRS, C. Mark Newton, MD HeartRhythm Case Reports Volume 5, Issue 2, Pages 88-92 (February 2019) DOI: 10.1016/j.hrcr.2018.10.011 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 A: High-resolution chest computed tomography (CT) during preprocedure work-up indicated an anterior-posterior membrane separating the left atrium into 2 subdivisions. B, C: Three-dimensional CT reconstructions (B: cranial view; C: posterior view) show that all 4 pulmonary veins (PVs) drained into the right subdivision of the atrium. L = left; R = right. HeartRhythm Case Reports 2019 5, 88-92DOI: (10.1016/j.hrcr.2018.10.011) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 Setup to visualize the 0.032” guidewire and NRG Transseptal Needle (Baylis Medical Company, Montreal, Canada) on the EnSite Velocity Cardiac Mapping System (St. Jude Medical, St. Paul, MN). A: The guidewire was connected to the pin box using an alligator cable for tracking up the superior vena cava. B: A DuoMode extension cable (Baylis Medical Company) was used to connect the radiofrequency (RF) needle to the recording system pin box to enable visualization during drop-down to the fossa ovalis. EAM = electroanatomic mapping. HeartRhythm Case Reports 2019 5, 88-92DOI: (10.1016/j.hrcr.2018.10.011) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 3 A, B: Radiofrequency (RF) needle movement (green dot) was tracked using 3-dimensional mapping from the superior vena cava (SVC) (A) toward the interatrial septum (IAS) (B). The white dot indicated the location of the first transseptal puncture (TSP). C: The needle was positioned on the IAS relative to the location of the first TSP before applying RF energy for the second TSP. D: Intracardiac echocardiography image indicating 1 sheath across the septum, as well as tenting by a second sheath and needle assembly prior to the second TSP. E: EnSite Velocity (St. Jude Medical, St. Paul, MN) voltage map showing individual ablation lesions (pink) and pulmonary vein isolation (gray). LA = left atrium; PV = pulmonary vein; RA = right atrium. HeartRhythm Case Reports 2019 5, 88-92DOI: (10.1016/j.hrcr.2018.10.011) Copyright © 2018 Heart Rhythm Society Terms and Conditions