Europace Advance Access originally published online on May 17, 2007
Europace 2007 9(7):496-497; doi:10.1093/europace/eum075
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ATRIAL FIBRILLATION ABLATION
High-density mapping at pulmonary veins antrum: a new tool for atrial fibrillation ablation
1 Institute of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, L.go Gemelli 8, 00168, Rome, Italy; 2 Institute of Radiology, Department of Bioimaging and Radiological Science, Catholic University of the Sacred Heart, Rome, Italy
Manuscript submitted 7 November 2006. Accepted after revision 29 March 2007.
* Corresponding author: Tel: +39 0630154187; fax: +39 063055535. E-mail address: michelacasella{at}hotmail.com
Key Words: Atrial fibrillation, Ablation, Pulmonary vein, Intracardiac echocardiography
A 58-year-old woman affected by drug refractory paroxysmal atrial fibrillation (AF) was referred for pulmonary veins (PV) disconnection by radiofrequency (RF) ablation. Bidimensional echocardiography documented normal left ventricular dimension and function; a moderate enlargement of left atrium (LA) was present. Before ablation, a cardiac contrast-enhanced computed tomography was performed with multidetector CT scanner (MDCT, LightSpeed Pro 16, GE, Phy-USA). The CT scan was loaded into an electroanatomic mapping system equipped with an image integration software (CartoMerge, Biosense Webster Inc.) to provide three-dimensional CT endocardial reconstruction of LA and PVs. Intracardiac echocardiography was performed using a Sequoia ultrasound system (Acuson Corporation, Siemens Medical Solutions USA, Inc.) with an AcuNav diagnostic ultrasound catheter introduced into the left femoral vein and advanced into the right atrium. Under fluoroscopic and intracardiac echocardiographic guidance, the transseptal puncture was performed and a long 11F deflectable sheath was introduced into the LA. A new technology high-density mapping catheter (HD Mesh Mapper, Bard Electrophysiology) was positioned at left superior PV antrum and expanded until a good contact was obtained. The correct position of the catheter was checked by electrogram recordings, fluoroscopy (Figure 1) and intracardiac echocardiography (Figure 2). RF applications, using an irrigated-tip catheter, were delivered at the antrum of the left superior PV and, subsequently, of left inferior, right superior, and right inferior PVs, until a complete LA–PV conduction block was achieved. Use of the high-density mapping catheter for LA–PV antrum is a new tool in electrophysiology; this case illustrates how it can allow a high-density definition of antral electrograms guiding RF applications and an optimal stability confirmed by intracardiac echocardiography.
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 Top Acknowledgements |
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The authors wish to thank Eng Lidia Visigalli and Eng Stefano Giovannoni for technical support.
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