scholarly journals Endocardial and epicardial activation maps for three-dimensional-perimitral flutter using a three-dimensional mapping system: A case report

2021 ◽  
Author(s):  
Tomoyuki Arai ◽  
Masao Takahashi ◽  
Rintaro Hojo ◽  
Seiji Fukamizu
Keyword(s):  
Superior Vena ◽  
Three Dimensional ◽  
Vena Cava ◽  
Posterior Wall ◽  
System A ◽  
Three Dimensional Mapping ◽  
Mapping System ◽  
Conduction Pathway ◽  
Linear Ablation ◽  
Total Activation

Abstract Background Perimitral flutter (PMF) is a macro-reentrant tachycardia, and mitral isthmus (MI) linear ablation is considered to be the preferable mode of treatment. Additionally, PMF can sometimes develop via epicardial connections, including coronary sinus and vein of Marshall. However, there are no reports of three-dimensional (3 D) atrial tachycardia (AT) via the intramural tissue. Case summary A 78-year-old man underwent catheter ablation for paroxysmal atrial fibrillation and AT, including pulmonary vein isolation, left atrial posterior wall isolation, superior vena cava isolation, and MI linear ablation in a total of four procedures. However, AT reoccurred, and he underwent a fifth procedure for AT. Although the MI block line was complete in both the endocardial and epicardial voltage maps, AT indicated PMF. The total activation time did not cover all phases of tachycardia cycle length due to the conduction pathway through the intramural muscle/bundles that could not be mapped with the addition of epicardial mapping. The tachycardia was terminated by ablation at the mitral valve annulus in the 2 o'clock position, where the bundles might have been attached. Discussion Both endocardial and epicardial activation maps indicated 3 D-PMF, whose circuit included the intramural muscle and bundles in a tachycardia circuit. It is necessary to recognise AT, which is involved via intramural tissues.

scholarly journals Multicenter study of novel mapping technique to detect non-pulmonary vein triggers excluding the origin from left atrial posterior wall and superior vena cava

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Matsunaga ◽  
Y Egami ◽  
M Yano ◽  
M Yamato ◽  
R Shutta ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Superior Vena Cava ◽  
Left Atrial ◽  
Medical Center ◽  
Superior Vena ◽  
Vena Cava ◽  
Posterior Wall ◽  
Mapping Technique ◽  
Left Atrial Posterior ◽  
Self Reference

Abstract Background It has been reported that elimination of non-pulmonary vein (PV) triggers after PV isolation is a good predictor of atrial tachyarrhythmia free survival. However, precise mapping of triggers outside from superior vena cava (SVC) or left atrial posterior wall (LAPW) are difficult. The aim of this study is to assess the efficacy of self-reference mapping technique to eliminate non-PV triggers originated from outside of primordial pulmonary vein area. Methods Total of 431 patients (446 procedures) underwent atrial fibrillation (AF) ablation in a hospital and in a medical center from January 2017 to March 2019. After isolation of PV, non-PV triggers were induced with isoproterenol and/or adenosine triphosphate. Reproducible non-PV triggers were targeted to ablate using following self-reference mapping technique: A trigger conducts centrifugally and the earliest site should be distinguished from other later activated sites. Using a PentaRay multipolar catheter, the operators annotated the earliest site of local activation and a reference tag was placed. The multipolar catheter was then moved to the reference tag and the process repeated. Ultimately, we identified clusters of early circumferential activation and ablated. Results A total of 32 non-PV triggers excluding the origin from LAPW and SVC were induced in 23 patients. Nineteen triggers (59%) were located in the right atrium and 13 triggers (41%) in the left atrium (Figure 1). All triggers were eliminated with ablation and AF was non-inducible in all patients at the end of the procedure. During the follow-up (529±270 days), 18 patients (77%) were free from atrial tachyarrhythmias after a 3-month blanking period. Three patients received additional ablation procedures for recurrent atrial arrhythmias. No non-PV triggers ablated during the previous procedure were observed. Conclusion A novel self-reference mapping technique is useful for eliminating non-PV triggers in terms of the short- and long-term success. Figure 1. Distribution of non-PV triggers Funding Acknowledgement Type of funding source: None

Usefulness of real-time three-dimensional trans-oesophageal echocardiography for detection of isolated unroofed coronary sinus

2014 ◽  
Vol 25 (1) ◽  
pp. 181-183 ◽  
Author(s):  
Yusuke Nakano ◽  
Mari Iwamoto ◽  
Munetaka Masuda
Keyword(s):  
Real Time ◽  
Coronary Sinus ◽  
Surgical Repair ◽  
Superior Vena ◽  
Three Dimensional ◽  
Vena Cava ◽  
Definite Diagnosis ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
Unroofed Coronary Sinus

AbstractWe report a case of unroofed coronary sinus not associated with the persistent left superior vena cava. Definite diagnosis of the unroofed coronary sinus was obtained by trans-oesophageal echocardiography, which revealed the unroofed portion with left-to-right shunt. Real-time three-dimensional trans-oesophageal echocardiography could show the whole pictures of the defect, which was useful information for surgical repair.

scholarly journals Benefits of early intervention with catheter ablation in patients with atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Mohanty ◽  
C Trivedi ◽  
D G Della Rocca ◽  
C Gianni ◽  
B MacDonald ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Early Intervention ◽  
Catheter Ablation ◽  
Success Rate ◽  
Therapeutic Option ◽  
Superior Vena ◽  
Vena Cava ◽  
Posterior Wall ◽  
Early Group ◽  
Late Group

Abstract Background Radiofrequency catheter ablation, a widely recognized therapeutic option for atrial fibrillation (AF) has limited success rate as it is influenced by several factors including duration of AF. Purpose We evaluated the ablation success in AF patients intervened early versus late in the disease course. Methods Consecutive AF patients undergoing their first catheter ablation in 2015–16 at our center were included in the analysis. Patients were classified into two groups based on the time to ablation after AF diagnosis; 1) early: ≤12 months and 2) late: >12 months. All received PV isolation plus isolation of posterior wall and superior vena cava. Additionally, in non-paroxysmal AF cases, non-PV triggers were identified with isoproterenol-challenge and ablated. Patients were prospectively followed up for 3 years with regular rhythm monitoring. Results A total of 752 and 1248 patients were included in the “early” and “late” group respectively. Baseline characteristics of the study population is provided in Table 1 A. At 4 years of follow-up, overall success rate off-antiarrhythmic drugs was significantly higher in the “early” group (65.4% vs 57%, p<0.001). After stratification by AF type, “early” group was still associated with significantly higher success rate compared to the “late” group (Table 1B). Conclusion In this large series with standardized ablation strategy, early intervention with catheter ablation was associated with higher success rate in all AF types. FUNDunding Acknowledgement Type of funding sources: None. Table 1

Is It Possible to Perform a Linear Lesion with No Local Electrograms Using a Three-Dimensional Mapping System for the Ablation of Typical Atrial Flutter?

Cardiology ◽  
2007 ◽  
Vol 108 (4) ◽  
pp. 358-362
Author(s):  
Carmine Muto ◽  
Luca Ottaviano ◽  
Michelangelo Canciello ◽  
Giovanni Carreras ◽  
Salvatore Angelini ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Three Dimensional ◽  
Three Dimensional Mapping ◽  
Typical Atrial Flutter ◽  
Mapping System ◽  
Dimensional Mapping

The heart, pericardium, and mediastinum

2013 ◽  
Author(s):  
Martin E. Atkinson
Keyword(s):  
Aortic Arch ◽  
Superior Vena ◽  
Vena Cava ◽  
Posterior Wall ◽  
Thoracic Vertebrae ◽  
Superior Mediastinum ◽  
Great Vessels ◽  
Imaginary Line ◽  
Phrenic Nerves ◽  
The Right

The heart, the arteries and veins leaving and entering the heart which are usually referred to as the great vessels, the trachea and bronchi, the oesophagus, and the vagus and phrenic nerves and sympathetic chains occupy the mediastinum , the area in the middle of the thoracic cavity between the two pleural sacs. The anteroposterior dimension of the thorax is narrowest in the mediastinum because of the presence of the thoracic vertebrae posteriorly. Laterally, the pleural sacs enclosing the lungs extend much further back alongside the vertebrae in the areas known as the paravertebral gutters. The great vessels enter and leave the superior aspect of the heart. The large veins draining the head, neck, and arms lie most superficially; they unite to form the superior vena cava that enters the right atrium of the heart. These veins overlie the two large arteries exiting the heart, the aorta, and pulmonary trunk. The aorta has a short ascending part, then forms the aortic arch passing backwards and to the left before continuing down the posterior wall of the thorax as the descending thoracic aorta. The subclavian and common carotid arteries, supplying blood to the arms and head and neck, respectively, arise from the aortic arch. The oesophagus is the deepest structure lying on the vertebrae and the trachea and main bronchi lie superficial to it. The sympathetic chains lie lateral to the vertebral bodies and the vagus and phrenic nerves are in intermediate positions. All these structures will be described in more detail in the rest of this chapter. The mediastinum is divided, for descriptive convenience, into the superior and inferior mediastinum. Figure 12.1 shows the imaginary line of division joining the sternal angle and the intervertebral disc below T4 that demarcates the boundaries of the superior and inferior of the mediastinum. The superior mediastinum occupies the space between the thoracic inlet above and the imaginary horizontal plane. The inferior mediastinum lies below that line and extends as far as the diaphragm. The lateral borders of both subdivisions of the mediastinum are the parietal pleura covering the medial aspect of the lungs, the mediastinal pleura.

Use of a New Non-Fluoroscopic Three-Dimensional Mapping System in Type I Atrial Flutter Ablation

2005 ◽  
Vol 28 (s1) ◽  
pp. S99-S101 ◽  
Author(s):  
THIERRY VERBEET ◽  
JOSÉ CASTRO ◽  
MARIELLE MORISSENS ◽  
EMMANUEL T. NGOC ◽  
PIERRE DECOODT
Keyword(s):  
Atrial Flutter ◽  
Three Dimensional ◽  
Type I ◽  
Three Dimensional Mapping ◽  
Mapping System ◽  
Dimensional Mapping ◽  
Atrial Flutter Ablation
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