Presentation is loading. Please wait.

Presentation is loading. Please wait.

Parasternal intercostal approach as an alternative to subxiphoid approach for epicardial catheter ablation: A case report  Koji Miyamoto, MD, Takashi.

Published byCamron Lester Modified over 5 years ago

Similar presentations

Presentation on theme: "Parasternal intercostal approach as an alternative to subxiphoid approach for epicardial catheter ablation: A case report  Koji Miyamoto, MD, Takashi."— Presentation transcript:

1 Parasternal intercostal approach as an alternative to subxiphoid approach for epicardial catheter ablation: A case report  Koji Miyamoto, MD, Takashi Noda, MD, PhD, Takeshi Aiba, MD, PhD, Kengo Kusano, MD, PhD  HeartRhythm Case Reports  Volume 1, Issue 3, Pages (May 2015) DOI: /j.hrcr Copyright © 2015 Heart Rhythm Society Terms and Conditions

2 Figure 1 Computed tomographic (CT) image of pericardial access. Transverse views (A–F) corresponding to the anteroposterior view (G) on preprocedural contrast-enhanced CT are shown. Note that the liver and stomach are present throughout the subdiaphragmatic space in the upper abdomen, which are on the trajectory for the subxiphoid epicardial approach. The epicardial needle was inserted at the 5th intercostal space (arrow), where was consistent with plane B. We confirmed by CT that no vital structures, including liver, stomach, transverse colon, and ITAs, were located on the needle trajectory. To avoid the ITAs (red circles), we selected a site 2.5 cm lateral to the parasternal border for needle entry (arrow). I: Avoidance of vital structures was also confirmed by echocardiography. Arrow indicates the entry site of the needle. H: The pigtail catheter was indwelling in the epicardial space after the procedure. Asterisk indicates location of epicardial needle entry for the parasternal intercostal approach. Arrowhead indicates location of needle entry for the standard subxiphoid approach. ITA = internal thoracic artery. HeartRhythm Case Reports 2015 1, DOI: ( /j.hrcr ) Copyright © 2015 Heart Rhythm Society Terms and Conditions

3 Figure 2 Fluoroscopic images of epicardial access by the parasternal intercostal approach (A, B) and right coronary angiography (C, D). Panels A and C are left anterior oblique views; panels B and D are anteroposterior views. Arrow indicates the 5th intercostal space. There are no coronary arteries, including the right ventricular marginal artery, on the trajectory of the epicardial access from the entry site at the parasternal 5th intercostal space to the heart. Asterisk indicates location of epicardial needle entry to the heart. HeartRhythm Case Reports 2015 1, DOI: ( /j.hrcr ) Copyright © 2015 Heart Rhythm Society Terms and Conditions

4 Figure 3 Bipolar voltage maps of the epicardium (A) and endocardium (B) of the left ventricle. The low-voltage zone (LVZ) was defined as <1.0 mV in the epicardium and 1.5 mV in the endocardium. Representative electrograms at the LVZ are also shown. A: Epicardial voltage mapping. Left panel is anteroposterior (AP) view and right panel is left posterior oblique view. B: Endocardial voltage mapping. Left panel is AP view and right panel is left lateral view. HeartRhythm Case Reports 2015 1, DOI: ( /j.hrcr ) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Download ppt "Parasternal intercostal approach as an alternative to subxiphoid approach for epicardial catheter ablation: A case report  Koji Miyamoto, MD, Takashi."

Similar presentations

Epicardial access and ventricular tachycardia ablation in a postmyocarditis patient using a nonfluoroscopic catheter visualization system  Akiko Ueda,

Epicardial access and ventricular tachycardia ablation in a postmyocarditis patient using a nonfluoroscopic catheter visualization system  Akiko Ueda,
Accelerated idioventricular rhythm after left atrial tachycardia ablation as a marker of acute coronary ischemia  John Whitaker, MB, BCh, MRCP, Hariharan.

Accelerated idioventricular rhythm after left atrial tachycardia ablation as a marker of acute coronary ischemia  John Whitaker, MB, BCh, MRCP, Hariharan.
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.
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 
Volume 11, Issue 1, Pages (January 2014)

Volume 11, Issue 1, Pages (January 2014)
Stereotactic radiosurgery as a treatment for recurrent ventricular tachycardia associated with cardiac fibroma  Jana Haskova, MD, Petr Peichl, MD, PhD,

Stereotactic radiosurgery as a treatment for recurrent ventricular tachycardia associated with cardiac fibroma  Jana Haskova, MD, Petr Peichl, MD, PhD,
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 
Acute right coronary artery occlusion after radiofrequency catheter ablation of cavotricuspid isthmus: Vascular response assessed by optical frequency.

Acute right coronary artery occlusion after radiofrequency catheter ablation of cavotricuspid isthmus: Vascular response assessed by optical frequency.
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,
Andreu Porta-Sánchez, MD, Andrew C. T

Andreu Porta-Sánchez, MD, Andrew C. T
First case of epicardial ablation to coexistent J waves in the inferior leads in a patient with clinical diagnosis of Brugada syndrome  Shingo Maeda,

First case of epicardial ablation to coexistent J waves in the inferior leads in a patient with clinical diagnosis of Brugada syndrome  Shingo Maeda,
To the Editor— Leftward on left anterior oblique is not always septal!

To the Editor— Leftward on left anterior oblique is not always septal!
Successful elimination of recurrent ventricular tachycardia by epicardial ablation over coronary artery supplying postinfarction aneurysm  Kenichiro Yamagata,

Successful elimination of recurrent ventricular tachycardia by epicardial ablation over coronary artery supplying postinfarction aneurysm  Kenichiro Yamagata,
Epicardial substrate ablation for Brugada syndrome

Epicardial substrate ablation for Brugada syndrome
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,
Ablation of epicardial ventricular tachycardia in a chagasic patient with situs inversus totalis: A case report  Lucas Hollanda Oliveira, MD, MSc, Enia.

Ablation of epicardial ventricular tachycardia in a chagasic patient with situs inversus totalis: A case report  Lucas Hollanda Oliveira, MD, MSc, Enia.
An interesting case of reverse electrical remodeling of the left atrium after radiofrequency ablation  Bharath Yarlagadda, MD, Tawseef Dar, MD, Valay.

An interesting case of reverse electrical remodeling of the left atrium after radiofrequency ablation  Bharath Yarlagadda, MD, Tawseef Dar, MD, Valay.
Accelerated idioventricular rhythm after left atrial tachycardia ablation as a marker of acute coronary ischemia  John Whitaker, MB, BCh, MRCP, Hariharan.

Accelerated idioventricular rhythm after left atrial tachycardia ablation as a marker of acute coronary ischemia  John Whitaker, MB, BCh, MRCP, Hariharan.
Radiofrequency catheter ablation for drug-refractory paroxysmal atrial fibrillation in a patient with Ebstein’s anomaly  Yong-Giun Kim, MD, Shin-Jae Kim,

Radiofrequency catheter ablation for drug-refractory paroxysmal atrial fibrillation in a patient with Ebstein’s anomaly  Yong-Giun Kim, MD, Shin-Jae Kim,

Similar presentations

Ads by Google