Cavotricuspid isthmus high-density mapping

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Date of download: 9/19/2016 Copyright © The American College of Cardiology. All rights reserved. From: Noncontact three-dimensional mapping and ablation.

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Presentation transcript:

Cavotricuspid isthmus high-density mapping Antonio De Simone, MD, Vincenzo La Rocca, MD, Francesco Solimene, MD, Francesco Maddaluno, BS, Maurizio Malacrida, BS, Giuseppe Stabile, MD HeartRhythm Case Reports Volume 2, Issue 5, Pages 372-376 (September 2016) DOI: 10.1016/j.hrcr.2016.03.013 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 A: The ablation catheter records split electrograms all along the ablation line. The interval between electrogram components is 120 milliseconds. B–G: Propagation map in the right atrium during coronary sinus (CS) pacing after the presumed cavotricuspid isthmus (CTI) block. The dark red area shows the portion of the right atrium that is activated within 10 milliseconds in various portions of the mapping window, which are labeled from B to G. Its extension gives an idea of how fast the wavefront is propagating inside the cardiac chamber B: The wavefront propagated from the CS ostium toward the CTI (since we were pacing from the CS ostium). C: The wavefront reached the CTI area (where the ablation line had been performed). D: The propagation wavefront was still at the isthmus area. However, the narrowing of the dark red area indicated the presence of a very slow conduction at this area. E: The propagation wavefront was able to cross the isthmus area activating a portion of the lateral wall. F: A larger portion of the lateral wall was activated by the propagation wavefront (resulting in a greater dark red area). G: The upper lateral wall was activated. HeartRhythm Case Reports 2016 2, 372-376DOI: (10.1016/j.hrcr.2016.03.013) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 A: The electrical signals detected by the Orion catheter along the ablation line during the remap of the right atrium while pacing from the coronary sinus with B: the roving probe. Fractionated signals, with a third distinct potential (arrow) were observed at this spot of slowed conduction. C: In the same spot indicated by the roving probe in B, the ablation catheter displays 2 atrial split components, completely filtering out the high-frequency multicomponent signals detected by the Orion catheter. HeartRhythm Case Reports 2016 2, 372-376DOI: (10.1016/j.hrcr.2016.03.013) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 A propagation map in the right atrium during coronary sinus pacing after 2 additional radiofrequency pulses. The propagation of the wave front from A to F shows that complete cavotricuspid isthmus block is achieved. G: The disappearance of the second potential of the fractioned potential was recorded in the same spot indicated by the roving probe in Figure 2. HeartRhythm Case Reports 2016 2, 372-376DOI: (10.1016/j.hrcr.2016.03.013) Copyright © 2016 Heart Rhythm Society Terms and Conditions