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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,

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Presentation on theme: "Long-standing persistent atrial fibrillation ablation without use of fluoroscopy in a patient with cor triatriatum  Saumil R. Shah, MD, Guru P. Mohanty,"— Presentation transcript:

1 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 (February 2019) DOI: /j.hrcr Copyright © 2018 Heart Rhythm Society Terms and Conditions

2 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: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

3 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: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

4 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: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

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