Getting to the right left atrium: Catheter ablation of atrial fibrillation and mitral annular flutter in cor triatriatum Ryan T. Borne, MD, Jaime Gonzalez,

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Presentation transcript:

Getting to the right left atrium: Catheter ablation of atrial fibrillation and mitral annular flutter in cor triatriatum Ryan T. Borne, MD, Jaime Gonzalez, MD, Amber Khanna, MD, William H. Sauer, MD, FHRS, Duy Thai Nguyen, MD, FHRS HeartRhythm Case Reports Volume 2, Issue 6, Pages 502-505 (November 2016) DOI: 10.1016/j.hrcr.2016.08.002 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Axial cardiac computed tomography (A) and transesophageal echocardiogram (B) demonstrating the delineation of the superior-posterior (red arrow) and inferior-anterior (blue arrow) partitions of the left atrium. HeartRhythm Case Reports 2016 2, 502-505DOI: (10.1016/j.hrcr.2016.08.002) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 A: Carto electroanatomic map. Red tags are ablation lesions resulting in wide antral pulmonary vein isolation (PVI), left atrial roof line, and mitral annular ablation lines. Green line represents the atrial membrane. B, C: Intracardiac echocardiography showing the ablation catheter (green tip) in the superior-posterior (B) and inferior-anterior (C) partition of the left atrium while performing PVI of the left pulmonary veins. HeartRhythm Case Reports 2016 2, 502-505DOI: (10.1016/j.hrcr.2016.08.002) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Demonstrating bidirectional block across the mitral annular line. Pacing distal coronary sinus catheter shows differential activation—the area of latest activation (deep blue isochrone) was directly medial to the mitral annular line. Pacing from the ablator (yellow stars) at 2 different medial sites demonstrated differential pacing (pacing from a site closer to the mitral annular line resulted in a longer conduction time). Similar pacing maneuvers were performed on the lateral side of the line to confirm bidirectional block. HeartRhythm Case Reports 2016 2, 502-505DOI: (10.1016/j.hrcr.2016.08.002) Copyright © 2016 Heart Rhythm Society Terms and Conditions