Radiofrequency ablation of common atrial flutter via right subclavian/jugular vein access in a patient with bilateral lower limb venous obstruction: Importance.

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Presentation transcript:

Radiofrequency ablation of common atrial flutter via right subclavian/jugular vein access in a patient with bilateral lower limb venous obstruction: Importance of contact force monitoring during mapping and ablation Yoshihiko Kagawa, MD, Eitaro Fujii, MD, PhD, Satoshi Fujita, MD, Takashi Omura, MD, Masaaki Ito, MD PhD HeartRhythm Case Reports Volume 1, Issue 6, Pages 486-489 (November 2015) DOI: 10.1016/j.hrcr.2015.08.004 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Venography images from 30-year-old patient. A: Selective venogram of the right femoral vein confirming occlusion of the right femoral vein. B: Selective venogram of the left femoral vein confirming occlusion of the left iliac vein. C: Selective venogram of the left basilic vein confirming occlusion of the left subclavian vein. HeartRhythm Case Reports 2015 1, 486-489DOI: (10.1016/j.hrcr.2015.08.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 Electrophysiological study of 30-year-old patient. A: 30° right anterior oblique fluoroscopic view. B: 45° left anterior oblique fluoroscopic view. CS = coronary sinus; RF = radiofrequency ablation catheter. HeartRhythm Case Reports 2015 1, 486-489DOI: (10.1016/j.hrcr.2015.08.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 Intracardiac electrograms and electroanatomical mapping from 30-year old patient. A: Intracardiac electrograms generated during tachycardia. Atrial flutter cycle length was 256 ms and 3:1 atrioventricular conduction was detected. II, aVF, V5 = surface electrocardiographic leads II, aVF, V5; ABL 1-2 = distal electrogram of the ablation catheter; ABL 3-4 = proximal electrogram of the ablation catheter; CS1-2 through 9-10 = distal to proximal electrogram of the coronary sinus catheter. B: Activation map generated during tachycardia at left lateral view of the right atrium. The activation wavefront is found to revolve in a counterclockwise manner around the tricuspid annulus. The colors represent early (red) to late (purple) activation. The force display was used to monitor contact force and direction during cavotricuspid isthmus ablation. Green tag: tricuspid annulus; pink tag: coronary sinus ostium; brown tag: ablation site. HeartRhythm Case Reports 2015 1, 486-489DOI: (10.1016/j.hrcr.2015.08.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions