Presentation is loading. Please wait.

Presentation is loading. Please wait.

Role of intracardiac echocardiography for guiding ablation of tricuspid valve arrhythmias  Andres Enriquez, MD, Carlos Tapias, MD, Diego Rodriguez, MD,

Published byAmie Franklin Modified over 6 years ago

Similar presentations

Presentation on theme: "Role of intracardiac echocardiography for guiding ablation of tricuspid valve arrhythmias  Andres Enriquez, MD, Carlos Tapias, MD, Diego Rodriguez, MD,"— Presentation transcript:

1 Role of intracardiac echocardiography for guiding ablation of tricuspid valve arrhythmias 
Andres Enriquez, MD, Carlos Tapias, MD, Diego Rodriguez, MD, Juan Ramirez, MD, Raphael Rosso, MD, Sami Viskin, MD, Robert Schaller, DO, FHRS, Francis Marchlinski, MD, FHRS, Luis Saenz, MD, Fermin Garcia, MD  HeartRhythm Case Reports  Volume 4, Issue 6, Pages (June 2018) DOI: /j.hrcr Copyright © 2018 Heart Rhythm Society Terms and Conditions

2 Figure 1 A, B: Anatomy of the tricuspid valve (TV). (Reproduced from Dr K. Shivkumar with permission. Copyright UCLA Cardiac Arrhythmia Center, McAlpine Collection.) C, D: Computed tomography image of the heart showing the right ventricle inflow and outflow regions to demonstrate the position of the ablation catheter from a femoral approach. C: Ablation of tricuspid annular ventricular arrhythmias from an inferior approach limited by the ablation catheter being hindered by the anterior TV leaflet. D: Infratricuspid approach using a steerable sheath and a reversed S-curve allows to overcome this obstacle and reach the subvalvular tissue. AL = anterior leaflet; Ao = aorta; APM = anterior papillary muscle; CS = crista supraventricularis; PL = posterior leaflet; PPM = posterior papillary muscle; PV = pulmonic valve; SL = septal leaflet; SPM = septal papillary muscle. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

3 Figure 2 Ablation of premature ventricular contraction (PVC) mapped to the top of the tricuspid valve (TV). A: Image shows failure to eliminate the PVCs with the standard approach, guided by fluoroscopy. Sites recording His potentials are marked in yellow. B: Image shows incorporation of intracardiac echocardiography for real-time assessment of TV annulus/leaflets and catheter–tissue contact. The same site of earliest activation is approached with a double loop on the ablation catheter, avoiding the anterior leaflet and resulting in a perpendicular vector of contact. PVCs were quickly eliminated. RA = right atrium; RV = right ventricle; TV = tricuspid valve. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

4 Figure 3 A: Activation map of the right ventricle during atrial pacing showing earliest activation at 9 o’clock on the tricuspid annulus. B: Intracardiac echocardiography imaging of the lateral tricuspid valve (TV), showing a small pouch or recess (red arrow) immediately below the TV. C: Positioning of the catheter inside the pouch, demonstrated by the green mark. D: Left anterior oblique and right anterior oblique views showing the position of the catheter at the successful ablation site. E: Elimination of accessory pathway conduction during ablation. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

5 Supplemental Figure 1 Patient 2. A. Twelve-lead ECG of the clinical PVC. B. Electrogram at site of earliest activation. C. Activation map of the RV showing earliest site in red and His potentials in yellow. D. ICE view obtained with the ICE catheter in the RA. E. Integration of CARTO map and RAO fluoroscopic view, showing the position of the catheter at the time of successful ablation. F. PVC elimination. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

6 Supplemental Figure 2 Patient 3. A. Twelve-lead ECG of the clinical PVC. B. Standard approach limited by the presence of the TV leaflets. C. “Reversed S” technique with better reach to the subvalvular tissue. D. Integration of CARTO map and RAO fluoroscopic view, showing the position of the catheter at the time of successful ablation. E. PVC elimination. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

7 Supplemental Figure 3 Patient 5. A. Baseline ECG showing ventricular preexcitation compatible with right lateral accessory pathway. B, D. Initial failed ablation attempt (ICE visualization and fluoroscopic LAO view). ICE shows the presence of the TV leaflet between the catheter tip and the underlying ventricular myocardium. C, E. By advancing the sheath further into the RV and placing a closed loop on the ablation catheter, the tip is positioned below the TV leaflet, in direct contact with the annulus. Ablation in this spot resulted in successful accessory pathway elimination. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Download ppt "Role of intracardiac echocardiography for guiding ablation of tricuspid valve arrhythmias  Andres Enriquez, MD, Carlos Tapias, MD, Diego Rodriguez, MD,"

Similar presentations

Radiofrequency Ablation for Atrial Tachycardia and Atrial Flutter

Radiofrequency Ablation for Atrial Tachycardia and Atrial Flutter
How to map and ablate left ventricular summit arrhythmias

How to map and ablate left ventricular summit arrhythmias
Pulmonary sinus cusp mapping and ablation: A new concept and approach for idiopathic right ventricular outflow tract arrhythmias  Jinlin Zhang, MD, Cheng.

Pulmonary sinus cusp mapping and ablation: A new concept and approach for idiopathic right ventricular outflow tract arrhythmias  Jinlin Zhang, MD, Cheng.
Wolff-Parkinson-White syndrome due to a left atrial appendage–to–left ventricular connection: A case of a successful pathway elimination from inside of.

Wolff-Parkinson-White syndrome due to a left atrial appendage–to–left ventricular connection: A case of a successful pathway elimination from inside of.
HeartRhythm Case Reports

HeartRhythm Case Reports
Catheter ablation as a treatment of atrioventricular block

Catheter ablation as a treatment of atrioventricular block
Intramyocardial radiofrequency ablation of ventricular arrhythmias using intracoronary wire mapping and a coronary reentry system: Description of a novel.

Intramyocardial radiofrequency ablation of ventricular arrhythmias using intracoronary wire mapping and a coronary reentry system: Description of a novel.
Percutaneous transhepatic venous access for atrial tachyarrhythmia ablation in patients with single ventricle and interrupted inferior vena cava  Richard.

Percutaneous transhepatic venous access for atrial tachyarrhythmia ablation in patients with single ventricle and interrupted inferior vena cava  Richard.
Successful ablation of premature ventricular contractions originating from the inferoseptal process of the left ventricle using a coronary sinus approach 

Successful ablation of premature ventricular contractions originating from the inferoseptal process of the left ventricle using a coronary sinus approach 
John Green, MD, Zaid Aziz, MD, Hemal M. Nayak, MD, Gaurav A

John Green, MD, Zaid Aziz, MD, Hemal M. Nayak, MD, Gaurav A
Intraatrial reentrant tachycardia originating from the prior suture line of the baffle in a patient who underwent the Mustard operation: Ultra-high-density.

Intraatrial reentrant tachycardia originating from the prior suture line of the baffle in a patient who underwent the Mustard operation: Ultra-high-density.
Ablation of ventricular tachycardia from the aortic root after transcatheter aortic valve replacement  Uma N. Srivatsa, MBBS, MAS, FHRS, Eric J. Nordsieck,

Ablation of ventricular tachycardia from the aortic root after transcatheter aortic valve replacement  Uma N. Srivatsa, MBBS, MAS, FHRS, Eric J. Nordsieck,
Atypical inferoseptal accessory pathway connection associated with an aneurysm of the coronary sinus: Insight from a three-dimensional combined image.

Atypical inferoseptal accessory pathway connection associated with an aneurysm of the coronary sinus: Insight from a three-dimensional combined image.
Jeremy W. Docekal, MD, Gregory Francisco, MD, Joseph C. Lee, MD, FHRS 

Jeremy W. Docekal, MD, Gregory Francisco, MD, Joseph C. Lee, MD, FHRS 
Three-dimensional electroanatomical mapping to guide transseptal catheterization  Mark R. Bowers, MS, MD, Padraig Gearoid O'Neill, MD, FHRS, Rohit Bhaskar,

Three-dimensional electroanatomical mapping to guide transseptal catheterization  Mark R. Bowers, MS, MD, Padraig Gearoid O'Neill, MD, FHRS, Rohit Bhaskar,
A subtype of idiopathic ventricular fibrillation and its relevance to catheter ablation and genetic variants  Takahiko Nishiyama, MD, Yoshiyasu Aizawa,

A subtype of idiopathic ventricular fibrillation and its relevance to catheter ablation and genetic variants  Takahiko Nishiyama, MD, Yoshiyasu Aizawa,
Volume 15, Issue 1, Pages (January 2018)

Volume 15, Issue 1, Pages (January 2018)
Premature ventricular contractions with two QRS morphologies originate from one focus in great cardiac vein  Juan Ma, MD, Ke-Xiang Wu, MD, Yu-Bin Wang,

Premature ventricular contractions with two QRS morphologies originate from one focus in great cardiac vein  Juan Ma, MD, Ke-Xiang Wu, MD, Yu-Bin Wang,
Robert D. Schaller, DO, Mouhannad M. Sadek, MD, Jeffrey J

Robert D. Schaller, DO, Mouhannad M. Sadek, MD, Jeffrey J
Permanent His bundle pacing at the time of atrioventricular node ablation: A 3- dimensional mapping approach  Sukit Ringwala, MD, MPH, Bradley P. Knight,

Permanent His bundle pacing at the time of atrioventricular node ablation: A 3- dimensional mapping approach  Sukit Ringwala, MD, MPH, Bradley P. Knight,

Similar presentations

Ads by Google