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Europace Advance Access originally published online on October 25, 2007
Europace 2007 9(12):1141; doi:10.1093/europace/eum232
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

ATRIAL FIBRILLATION

Left atrial roof pouch

Rukshen Weerasooriya1,2,* and Conor Murray3

1 Department of Cardiology, Royal Perth Hospital, Wellington Street, GPO Box X2213, Perth, WA, Australia; 2 Department of Medicine, University of Western Australia, Crawley, WA, Australia; 3 Department of Clinical Imaging, Royal Perth Hospital, Wellington Street, Perth, WA, Australia

* Corresponding author. Tel: +61 8 9224 2244; fax: +61 8 9224 3175 E-mail address: rukshen{at}gmail.com

Linear ablation of the left atrial roof region has been proposed as a means of modifying the left atrial arrhythmogenic substrate and improved success rate has been demonstrated using this strategy. Discrete outpouching of the roof region has been recently described. We have found that these so-called ‘roof pouches’ can be very useful for merging the pre-ablation CT image with the electroanatomical mapping data. Figure 1 demonstrates an example of a roof pouch near the right superior pulmonary vein and slightly towards the anterior wall. Panel A is an anteroposterior view of an electroanatomical voltage map (CARTO, Biosense-Webster, Diamond Bar, USA). The pouch can be easily appreciated in this view. The pouch was used as a registration landmark and the CARTO merge software was applied. An excellent match was achieved from this single point registration (Figure 1B). During roof line ablation, care was taken to avoid ablation within the pouch because of the potential risk of impedance rise and pop phenomenon using externally irrigated ablation catheter (Navistar thermocool F curve, Biosense-Webster, Diamond Bar, USA).


Figure 1
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  		Figure 1 Left atrial roof pouch.

 

   Acknowledgements
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 Acknowledgements
 
The authors gratefully acknowledge the assistance of Leslie Quince of Biosense-Webster Australia for his technical expertise.

Conflict of interest: R.W. has received honoraria and lecture fees from Biosense-Webster.


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This Article
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