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Successful ablation for non-pulmonary multi-foci atrial fibrillation/tachycardia in a patient with coronary sinus ostial atresia by transseptal puncture.

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Presentation on theme: "Successful ablation for non-pulmonary multi-foci atrial fibrillation/tachycardia in a patient with coronary sinus ostial atresia by transseptal puncture."— Presentation transcript:

1 Successful ablation for non-pulmonary multi-foci atrial fibrillation/tachycardia in a patient with coronary sinus ostial atresia by transseptal puncture and epicardial approach  Yukihiro Inamura, MD, Junichi Nitta, MD, PhD, Akira Sato, MD, Masahiko Goya, MD, PhD, Mitsuaki Isobe, MD, PhD, Kenzo Hirao, MD, PhD, FHRS  HeartRhythm Case Reports  Volume 3, Issue 5, Pages (May 2017) DOI: /j.hrcr Copyright © 2017 Heart Rhythm Society Terms and Conditions

2 Figure 1 Transseptal approach to coronary sinus ostial atresia (CSA). Multidetector computed tomography revealed CSA. CSA had communication between the left atrium (LA) and the coronary sinus (CS) via the intraseptal vein. Transseptal puncture was performed by Brockenbrough needle and a steerable long sheath. CS angiography revealed ectasia and demonstrated the Marshall vein. AP = anterior posterior; LAO = left anterior oblique; LV = left ventricle; RA = right atrium; RAO = right anterior oblique; RV = right ventricle. HeartRhythm Case Reports 2017 3, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

3 Figure 2 Atrial tachycardia (AT) in the coronary sinus (CS) roof. Three-dimensional mapping of AT. The bottom of the left atrium (LA) and the low septal region of the right atrium (RA) were the earliest sites of activation according to LA and RA activation mapping, respectively. AT did not terminate even though ablation was performed at the earliest site of activation in the LA and RA. After the Brockenbrough puncture, AT was successfully eliminated by ablation at the earliest site of activation in the CS. ABL = ablation catheter; AP = anterior posterior; HRA = high right atrium. HeartRhythm Case Reports 2017 3, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

4 Figure 3 Hybrid endocardial and epicardial ablation at the vein of Marshall (VOM) site. Atrial fibrillation (AF) was temporarily terminated by ablation at the endocardial side of the VOM (arrow 1), but recurred after short time. AF was terminated by ablation in the VOM area (arrow 2), which was on the contralateral side of the endocardial site where partial success was achieved. AF foci were eliminated by hybrid endocardial and epicardial ablation. ABL = ablation catheter; IS = intraatrial septum; LALW = left atrium lateral wall; LAO = left anterior oblique; LAPW = left atrium posterior wall; LR = left-right; RA = right atrium; SVC = superior vena cava; TA = tricuspid annulus. HeartRhythm Case Reports 2017 3, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

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