scholarly journals Transseptal puncture through the atrial septal occluder in patient with atrial fibrillation for guided radiofrequency ablation procedure using remote magnetic navigation: A clinical case

2021 ◽  
Vol 25 (1) ◽  
pp. 114
Author(s):  
A. V. Ponomarenko ◽  
N. A. Yelemessov ◽  
I. S. Peregudov ◽  
R. E. Zhizhov ◽  
V. V. Baranova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Left Atrium ◽  
Conflict Of Interest ◽  
Clinical Case ◽  
Holter Monitoring ◽  
Interatrial Septum ◽  
Magnetic Navigation ◽  
Transseptal Puncture ◽  
Remote Magnetic Navigation

<p>Access to the left atrium during transseptal puncture for radiofrequency ablation in patients with atrial fibrillation (AF) and implanted atrial septal occluder can be challenging. This is particularly true when the occluder covers the entire septum and there is no ideal puncture site. This might lead to potential difficulties in arrhythmia treatment.<br />A 59-year-old patient with drug refractory AF, a dilated left atrium, and an implanted atrial septal occluder underwent double transseptal puncture through atrial septal occluder with subsequent pulmonary vein isolation using remote magnetic navigation. The effectiveness of the manipulation was confirmed by intraoperative stimulation from the Lasso catheter and by Holter monitoring data post-operation. It was revealed that the patient had sinus rhythm and no complications occurred. There were no shunts at the occluder level on transthoracic echocardiography, and there were no atrial tachyarrhythmias during the nine-month follow up period without antiarrhythmic drugs. The presented clinical case demonstrates the safety and efficacy of transseptal puncture through an implanted occluder in the interatrial septum to perform re-ablation using robotic magnetic navigation in a patient with AF.</p><p>Received 21 October 2020. Revised 20 November 2020. Accepted 25 November 2020.</p><p><strong>Funding:</strong> The work is supported by a grant of the President of the Russian Federation No. МД-1997.2020.7.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong> <br />Drafting the article: А.V. Ponomarenko, R.E. Zhizhov, V.V. Baranova, E.V. Fisher, A.B. Romanov<br />Literature review: А.V. Ponomarenko, R.E. Zhizhov, V.V. Baranova, E.V. Fisher<br />Illustrations: А.V. Ponomarenko, A.B. Romanov<br />Critical revision of the article: А.V. Ponomarenko, R.E. Zhizhov, V.V. Baranova, A.M. Chernyavskiy, A.B. Romanov<br />Surgical treatment: N.А. Yelemessov, I.S. Peregudov, V.V. Shabanov, A.B. Romanov<br />Final approval of the version to be published: А.V. Ponomarenko, N.А. Yelemessov, I.S. Peregudov, R.E. Zhizhov, V.V. Baranova, E.V. Fisher, V.V. Shabanov, A.M. Chernyavskiy, A.B. Romanov</p>

scholarly journals A case report of pulmonary vein isolation with radiofrequency catheter using superior vena cava approach in patient with paroxysmal atrial fibrillation and inferior vena cava filter

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Masatoshi Narikawa ◽  
Masayoshi Kiyokuni ◽  
Junya Hosoda ◽  
Toshiyuki Ishikawa
Keyword(s):  
Atrial Fibrillation ◽  
Inferior Vena Cava ◽  
Left Atrium ◽  
Inferior Vena ◽  
Superior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Transseptal Puncture ◽  
Mapping Catheter ◽  
Steerable Sheath

Abstract Background Transseptal puncture and pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) are generally performed via the inferior vena cava (IVC). However, in cases where the IVC is inaccessible, a specific strategy may be needed. Case summary An 86-year-old woman with paroxysmal AF and an IVC filter in situ was referred to our hospital for ablation therapy. An IVC filter for pulmonary embolism and deep venous thrombosis had been implanted 15 years prior, therefore we selected a transoesophageal echocardiography (TOE)-guided transseptal puncture using a superior vena cava (SVC) approach. After the single transseptal puncture, we performed fast anatomical mapping, voltage mapping by multipolar mapping catheter, and then PVI by contact force-guided radiofrequency catheter using a steerable sheath. Following the ablation, bidirectional conduction block between the four pulmonary veins and the left atrium was confirmed by both radiofrequency and mapping catheter. No complications occurred and no recurrence of AF was documented in the 12 months after the procedure. Discussion When performing a transseptal puncture during AF ablation, an SVC approach, via access through the right internal jugular vein, enables the sheath to directly approach the left atrium without angulation and improves operability of the ablation catheter. Combining the use of general anaesthesia, TOE, a steerable sheath, and contact force-guided ablation may contribute to achieving minimally invasive PVI with a single transseptal puncture via an SVC approach.

scholarly journals The Impact of Left Atrial Size in Catheter Ablation of Atrial Fibrillation Using Remote Magnetic Navigation

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Xiao-yu Liu ◽  
Hai-feng Shi ◽  
Jie Zheng ◽  
Ku-lin Li ◽  
Xiao-xi Zhao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Magnetic Navigation ◽  
Remote Magnetic Navigation ◽  
X Ray ◽  
Group A ◽  
Group B ◽  
The Impact

Objective. The objective of this study was to investigate the impact of left atrial (LA) size for the ablation of atrial fibrillation (AF) using remote magnetic navigation (RMN). Methods. A total of 165 patients with AF who underwent catheter ablation using RMN were included. The patients were divided into two groups based on LA diameter. Eighty-three patients had small LA (diameter <40 mm; Group A), and 82 patients had a large LA (diameter ≥40 mm; Group B). Results. During mapping and ablation, X-ray time (37.0 (99.0) s vs. 12 (30.1) s, P<0.001) and X-ray dose (1.4 (2.7) gy·cm2 vs. 0.7 (2.1) gy·cm2, P=0.013) were significantly higher in Group A. No serious complications occurred in any of the patients. There was no statistical difference in the rate of first anatomical attempt of pulmonary vein isolation between the two groups (71.1% vs. 57.3%, P=0.065). However, compared with Group B, the rate of sinus rhythm was higher (77.1% vs. 58.5%, P<0.001) during the follow-up period. More patients in Group A required a sheath adjustment (47/83 vs. 21/82, P<0.001), presumably due to less magnets positioned outside of the sheath. In vitro experiments with the RMN catheter demonstrated that only one magnet exposed created the sheath affects which influenced the flexibility of the catheter. Conclusions. AF ablation using RMN is safe and effective in both small and large LA patients. Patients with small LA may pose a greater difficulty when using RMN which may be attributed to the fewer magnets beyond the sheath. As a result, the exposure of radiation was increased. This study found that having at least two magnets of the catheter positioned outside of the sheath can ensure an appropriate flexibility of the catheter.

Abstract 4649: A Radiofrequency HOT Balloon Catheter for Isolating the Posterior Left Atrium Including All the Pulmonary Veins in the Treatment of Atrial Fibrillation: Feasibility and Safety of a New Approach

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hiroshi Sohara ◽  
Shutaro Satake ◽  
Hiroshi Takeda ◽  
Hideki Ueno ◽  
Toshimichi Oda
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Phrenic Nerve ◽  
Pulmonary Veins ◽  
Balloon Catheter ◽  
Holter Monitoring ◽  
Phrenic Nerve Palsy ◽  
Total Procedure Time ◽  
Successful Isolation

Atrial fibrillation (AF) is originated from mostly from pulmonary vein (PV) foci or non-PV foci in the posterior left atrium (PLA). The present study was designed to evaluate the usefulness of a radiofrequency HOT balloon catheter (RBC) for isolation of the PLA including all PVs en masse in the patients with AF. In a total of 96 patients (75 men and 21 women; mean age 64±8 years old) with drug-resistant paroxysmal (n=63) and persistent AF(n=33), PLA including all PVs were ablated and isolated using RBC. Dragging the balloon, contiguous lesions at the roof between the superior PVs were first created, then each antrum of all PVs were ablated, and finally, contiguous lesions at the PLA between the both inferior PVs were made, while we performed monitoring esophagus temperature and phrenic nerve pacing. Electro-anatomical bipolar voltage amplitude mapping (CARTO) of the LA-PVs was performed to determine the extent of this electrical isolation after all procedure. Successful isolation of the PLA including all PVs was achieved in all of 96 cases with elimination of all the PLA and PV potentials. The mean total procedure time 133 ± 31 minutes including 32±9 minutes fluoroscopy time. Recurrences of AF were diagnosed by Holter monitoring, mobile electrocardiogram. After first session, eighty- seven (59 paroxysmal, 28 persistent) of 96 patients were free from AF without anti-arrhythmic drugs and the remaining patients could maintain sinus rhythm with anti-arrhythmic drugs except two cases with LA flutter during 11.0±4.1 months follow-up. No major complications such as cerebral embolism, PV stenosis, or phrenic nerve palsy, and LA-esophageal fistula were observed. Complete isolation of the PLA including all PVs using a RBC, is useful for the treatment of both paroxysmal and persistent AF without severe complication.

scholarly journals Current ECG Aspects of Interatrial Block

Hearts ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 419-432
Author(s):  
Antoni Bayés-de-Luna ◽  
Miquel Fiol-Sala ◽  
Manuel Martínez-Sellés ◽  
Adrian Baranchuk
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Premature Death ◽  
Interatrial Septum ◽  
P Wave ◽  
Junction Zone ◽  
Electrical Impulse ◽  
Wave Morphology ◽  
Atrial Activation ◽  
Interatrial Block

Interatrial blocks like other types of block may be of first degree or partial second degree, also named transient atrial block or atrial aberrancy, and third degree or advanced. In first degree, partial interatrial block (P-IAB), the electrical impulse is conducted to the left atrium, through the Bachmann’s region, but with delay. The ECG shows a P-wave ≥ 120 ms. In third-degree, advanced interatrial block (A-IAB), the electrical impulse is blocked in the upper part of the interatrial septum (Bachmann region); the breakthrough to LA has to be performed retrogradely from the AV junction zone. This explains the p ± in leads II, III and aVF. In typical cases of A-IAB, the P-wave morphology is biphasic (±) in leads II, III and aVF, because the left atrium is activated retrogradely and, therefore, the last part of the atrial activation falls in the negative hemifield of leads II, III and aVF. Recently, some atypical cases of A-IAB have been described. The presence of A-IAB is a risk factor for atrial fibrillation, stroke, dementia, and premature death.

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