A novel mapping and ablation strategy of the mitral isthmus using intracardiac echocardiography in the left atrium Thomas J. Flautt, DO, Alison L. Spangler,

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Date of download: 6/25/2016 Copyright © The American College of Cardiology. All rights reserved. From: Mechanism, localization and cure of atrial arrhythmias.

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Presentation transcript:

A novel mapping and ablation strategy of the mitral isthmus using intracardiac echocardiography in the left atrium Thomas J. Flautt, DO, Alison L. Spangler, DO, John W. Prather, PhD, MD, David Z. Lan, MD HeartRhythm Case Reports Volume 5, Issue 2, Pages 80-82 (February 2019) DOI: 10.1016/j.hrcr.2018.10.010 Copyright © 2018 Terms and Conditions

Figure 1 Intracardiac echocardiography image in the left atrium (LA) revealing a thickened mitral isthmus (MI) of 8 mm (arrow measuring from the endocardial surface of the mitral isthmus to the coronary sinus [CS] during diastole). HeartRhythm Case Reports 2019 5, 80-82DOI: (10.1016/j.hrcr.2018.10.010) Copyright © 2018 Terms and Conditions

Figure 2 A left anterior oblique caudal view of the left atrium (LA). This is an inferior and anterolateral view of the LA looking superiorly. The mitral isthmus endocardial ablation line can be appreciated (red dots). The intracardiac echocardiography catheter (ICE) in the LA can be seen projecting a second image of the mitral isthmus and coronary sinus (CS). Also, a CS and ablation catheter can be seen in the CS and a CARTO PentaRay (Biosense Webster, Irvine, CA) catheter (PR) can be visualized in the left atrial appendage (LAA). LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein. HeartRhythm Case Reports 2019 5, 80-82DOI: (10.1016/j.hrcr.2018.10.010) Copyright © 2018 Terms and Conditions

Figure 3 Electrogram revealing change in coronary sinus (CS) activation (red arrows) during ablation in the CS. Pacing is from the left atrial appendage. Ablation distal (ABL d) is located in the CS at the thickest (8 mm) portion of the mitral isthmus. CSd = coronary sinus distal; CSp = coronary sinus proximal; LS = PentaRay catheter located in the left atrial appendage. HeartRhythm Case Reports 2019 5, 80-82DOI: (10.1016/j.hrcr.2018.10.010) Copyright © 2018 Terms and Conditions

Supplemental Figure 1 A: Horizontal image using CARTO 3-dimensional mapping technology (Biosense Webster). The ICE catheter (ICE) is in the left atrium near the mitral valve turned superiorly and posteriorly. B: Corresponding ICE image of the left atrium (LA). The left circumflex artery (LCx) and coronary sinus (CS) can be visualized. LAA = left atrial appendage; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein. HeartRhythm Case Reports 2019 5, 80-82DOI: (10.1016/j.hrcr.2018.10.010) Copyright © 2018 Terms and Conditions