EP Lab Digest - December 2007 - (Page 10)

10 COVER STORY DECEMBER 2007 IMPROVED ANATOMICAL ORIENTATION Continued from page 8 the ablation process using a single transseptal puncture, a single sheath, and a single catheter.We usually reconfirm bi-directional conduction block in and out of the PV antrum using the spiral catheter; however, the results are always in concordance with the ablation catheter's PV antrum mapping. After isolating the left- and right-sided Figure 9A. PA view of Persistent AF lesions. Figure 9B. LPO view. PV antrum in patients with persistent AF, we place a LA roof line and a line at the basal posterior LA (connecting the LLPV and RLPV). This way, a box at the posterior LA wall is created and complete isolation of the whole box is again achieved and verified using voltage and pace mapping. Eventually a left atrial isthmus line is placed as continuously and transFigure 9C. LL view. Figure 9D. RPO view. Figure 9E. Superior view. murally as possible. Line continuity is not enforced with additional electrophysiologically-defined complete learning process with any new technology. and to focus on the information that is electrical isolation of all PV antrums, and in As we were not frequent users of the important for the procedure. There is a CS ablations. At the end of the procedure, we test for patients with persistent/ permanent AF, EnSite System prior to the availability of great deal of information available AF inducibility with 20 seconds of aggres- additional isolation of the posterior box Fusion, we had to become familiar with through this mapping technology, but it is the interface, but this was quickly accom- not necessary to display everything on the sive burst stimulation at the atrial refractory lesion together with a mitral isthmus line. plished and we now find the system easy screen. Most importantly, stay openperiod; this is currently still without conseto use. It is important to take advantage of minded and develop the techniques that quences with respect to additional lesion Key Points and Conclusion One must acknowledge that there is a clinical support when learning the system, work best for you and your patients. creation. Our procedural endpoint is the To help us get accustomed to the EnSite system, we began by using the system on simple arrhythmias such as atrial flutter or AVNRT. Now AF is our major indication for use of the 3D system, and we are also using it regularly in more complex arrhythmias such as atrial macroreentrant tachycardias. In those cases we needed to introduce information derived from electrophysiological assessments such as activation, entrainment and voltage mapping, all of which can be nicely displayed on the integrated CT image, also without 3D chamber reconstruction. This provides a very fast and accurate understanding of the true anatomical location of the reentrant circuit. The basic ablation concepts described in this article have been used in our institution for some time. With the introduction of new technological capabilities, we are simply able to apply them better in the individual patient with his or her individual left atrial anatomy. Finally, because we are able to achieve this registration in a very short amount of time, it appears that this technology may provide the important benefit of saving time in our very busy EP lab. Figure 10. Tagging ablation sites as 3D lesions on EnGuide (true position of the catheter tip).

Table of Contents Feed for the Digital Edition of EP Lab Digest - December 2007

EP Lab Digest - December 2007 Improved Anatomical Orientation During AF Catheter Ablation: Experience from Leipzig Heart Center One EP Lab’s Solution to the Administration of Deep Sedation Contents Letter from the Editor Spotlight Interview: Northeast Georgia Medical Center Emerging Technologies for the Electrophysiology Lab The Western Atrial Fibrillation Symposium About the PRECEDE-HF Trial: Interview with William T. Abraham, MD, FACP, FACC, FAHA Overview on Shire and the Discontinuation of Ethmozine®: After the Heart Rhythm Society Intervenes, the Company Changes its Decision Minimizing the Risk of Infection at Children’s Sibley Heart Center: Interview with Nicole Jarrell, RNC, MSN, and J. Renee Watson, RN, CIC Is There a Link Between Gasoline Vapors and Brugada Syndrome? Interview with Darko Kranjcec, MD and Hugues Abriel, MD, PhD New Feature! Pacemaker/ICD Puzzle Email Discussion Group Events Calendar Industry News and Products

EP Lab Digest - December 2007

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