High-power bipolar ablation for incessant ventricular tachycardia utilizing a deep midmyocardial septal circuit William H. Sauer, MD, FHRS, David A.

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Presentation transcript:

High-power bipolar ablation for incessant ventricular tachycardia utilizing a deep midmyocardial septal circuit William H. Sauer, MD, FHRS, David A. Steckman, MD, Mathew M. Zipse, MD, Wendy S. Tzou, MD, FHRS, Ryan G. Aleong, MD, FHRS HeartRhythm Case Reports Volume 1, Issue 6, Pages 397-400 (November 2015) DOI: 10.1016/j.hrcr.2015.01.018 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Targeted septal ventricular tachycardia. The RV catheter is positioned on the mid-right ventricular septum, and the ablation catheter is positioned on the basal left ventricular septum. ABL = ablation; d = distal; RV = right ventricle. HeartRhythm Case Reports 2015 1, 397-400DOI: (10.1016/j.hrcr.2015.01.018) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 Left anterior oblique (LAO) fluoroscopy and intracardiac echo echocardiography demonstrating catheter positioning across the interventricular septum. Left panel: An LAO image depicting an 8-mm catheter within the right ventricle (RV) and a 3.5-mm open-irrigated catheter within the left ventricle (LV). Right panel: Intracardiac echocardiogram depicting the septal positioning of the RV and LV ablation catheters during bipolar radiofrequency ablation. When acute echogenicity or the presence of bubbles was seen on the intracardiac echocardiogram, as denoted by the asterisk, ablation was stopped. HeartRhythm Case Reports 2015 1, 397-400DOI: (10.1016/j.hrcr.2015.01.018) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 Depiction of the positioning of the active and ground catheters to maximize lesion depth and current density. When the catheters were positioned close together on opposite sides of the septum, we had greater baseline impedances and impedance declines as well as ventricular tachycardia termination that we presume to be due to an overall deeper lesion in the septum as depicted by the solid red semicircles. When the catheters were not closely positioned, the baseline impedance and impedance declines were less potentially indicative of less current density and a less than transmural lesion as depicted by black outlined semicircles. HeartRhythm Case Reports 2015 1, 397-400DOI: (10.1016/j.hrcr.2015.01.018) Copyright © 2015 Heart Rhythm Society Terms and Conditions