Europace Advance Access originally published online on August 7, 2007
Europace 2007 9(12):1142-1143; doi:10.1093/europace/eum158
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ATRIAL FIBRILLATION
Another use for radiofrequency energy during an atrial fibrillation ablation procedure
Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
* Corresponding author. Tel: +33 5 56 07 27 76; fax: +33 5 57 65 65 09. E-mail address: sebastien.knecht{at}chu-brugmann.be
A 25-year-old man with initial 9 months' symptomatic permanent atrial fibrillation in the context of hypertrophic cardiomyopathy was referred for a third procedure of catheter ablation planned because of symptomatic left atrial tachycardia recurrence.
No permeable foramen ovale was found. After a standard transseptal puncture approach using fluoroscopic landmarks, antero-posterior and left lateral projections as well as contrast injection towards the septum in both views confirmed the good positioning of the tip. The needle was then advanced to perforate the fossa ovalis but did not go through even by vigorously pushing the apparatus many times against the septum (Figure 1A).
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Ablation catheter was then brought into contact with the proximal extremity of the needle (Figure 1B), the tip of which being still in touch with the fossa ovalis. Thirty watts of radiofrequency energy was applied to the ablation catheter, which transmitted it to the needle. By acting like a surgeon's electric knife, the needle went through only after 1 s of application, which was confirmed by contrast injection (Figure 1C) and pressure monitoring (Figure 1D).
The transseptal sheath was advanced to the LA, and a perimitral macro re-entry was successfully cured by ablation.
This case demonstrates an original transvenous method to pass through the fossa ovalis, which can sometimes be impossible by conventional approach in case of fibrosis due to prior transseptal catheterization. Careful attention for the good positioning of the needle has to be paid to avoid serious complications.
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Acknowledgements |
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 Top Acknowledgements |
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S.K. is supported by the Belgian ‘Funds for Cardiac Surgery’.
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