01 December 2021>: Articles
Treatment of Macro-Reentry Atrial Tachycardia with Very High-Power, Short-Duration, Temperature-Controlled Ablation of Anterior Line Using an Open-Irrigated Ablation Catheter with Microelectrodes
Unusual clinical course, Unusual or unexpected effect of treatment, Educational Purpose (only if useful for a systematic review or synthesis)Christian Heeger A* , Julia Vogler C , Bettina Kirstein B , Charlotte Eitel B , Roland R. Tilz D
Am J Case Rep 2021; 22:e934081
Figure 2. Periprocedural electrocardiograms (ECGs): Prolongation of atrial tachycardia (AT) cycle lengths (CLs). (A) Surface and intracardiac ECGs at baseline. The atrial CL is stable at 300 ms. CS – coronary sinus catheter placed distal in the coronary sinus; spiral – spiral mapping catheter placed inside the left atrial appendage (LAA); Ablation (Abl) d – distal electrodes on the map catheter; Abl p – proximal electrodes on the map catheter; Abl u1-u2, Abl u2-u3, Abl u1-u3 – microelectrodes; A – atrium; V – ventricle. Speed 100 mm/s. (B) An electroanatomic map of the left atrium utilizing CARTO 3, V7 (Biosense Webster). Left side, right anterior oblique view. A local activation time map with evidence of a peri-mitral AT, suggesting the critical isthmus at the anterior wall (white arrow). Coppery area – zone of slow or no conduction. Right side, left anterior oblique (LAO) view. A voltage map with evidence of a large scar area on the anterior wall. The bipolar voltage reference interval was set between 0.1 mV and 0.5 mV. (C) Surface and intracardiac electrocardiograms at prolongation of CL during ablation of the anterior wall near the mitral annulus. Note the prolongation of atrial CLs from 300 ms to 400 ms to 700 ms after starting radiofrequency (RF) ablation with 90 W/4 s. The black arrows indicate small potentials on the microelectrodes. There are no signals visible on the Abl d and Abl p electrodes. The total RF ablation time at CL prolongation was 12 s. CS – coronary sinus catheter placed distal in the coronary sinus; spiral – spiral mapping catheter placed inside the LAA; Abl d – distal electrodes on the map catheter; Abl p – proximal electrodes on the map catheter; Abl u1–u2, Abl u2–u3, Abl u1–u3 – microelectrodes; A – atrium; V – ventricle; black triangle – start of ablation; black star – prolongation of CL. Speed 100 mm/s. (D) An electroanatomic map of the left atrium during ablation of the anterior wall. Left side, right anterior oblique view; right side, LAO oblique view. Note the ablation catheter in the anterior wall during delivery of a very high-power short-duration application of 90 W/4 s. The contact force was 19 g and the distance from the previous application was 4.7 mm. The “bullseye” in the left upper corner indicates the temperature of the ablation catheter tip. Source: Property of C. Heeger.