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To indicate reference points, the catheter position was also shaded such that the catheter's original position was well-marked if the catheter was dislodged.

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For the left bundle branch, we performed a right femoral artery puncture and inserted the catheter ablation in a retrograde manner through the aorta using the technique described above. For each patient, atrial and ventricular stimulation were performed to diagnose the arrhythmias. The database was maintained in Microsoft Excel The data were used to calculate means and percentages. Statistical analyses were performed using SPSS v.

Three catheters two diagnostic catheters and an ablation catheter were used in the examination except for the patient with VES, for whom one diagnostic and one ablation catheter was used. In the three patients with AFL, ablation catheters with an 8 mm tip were used, whereas 4 mm catheters were used for the remaining patients.


The WPW patients presented with left lateral bundles and anterograde conduction. Both VES patients had a focused arrhythmia in the right ventricle outflow. The mean total duration for the procedure was The mean number of radio frequency energy applications was Table 1 shows a summary for such data. In one AFL patient who presented with a left atrial arrhythmia, ablation was not performed.

In our center, consent is not routinely required to perform a transseptal puncture in all cases. In such instances, the left side was not approached, and the patient was informed after examination that a left catheterization was necessary, which is a procedure that was scheduled for another time. However, the ablation line in the cavotricuspid isthmus was not bidirectionally blocked even after numerous lines were performed in the isthmus region with low voltage.

One reason for this observation may be lower-loop reentry. However, the activation map under atrial stimulation did not unequivocally demonstrate such an event. There were no complications during the procedures; the patients were also discharged without complications. Fluoroscopy was not used for the cases herein. Catheter positioning during nodal reentrant tachycardia ablation. The left image right anterior oblique view shows the catheter shadows that identify the right branch and His bundle region. Notably, the His potential was identified in a region up to 1 cm high.

Such is noted in the right image left anterior oblique view , and three levels of His were observed; one was more caudal, one was intermediary, and the third was more cranial. In part, such observations may be due to heart movement and altered thoracic impedance during deep inspiration.

Catheter Ablation for Arrhythmias

However, it is important to define this region for safe radiofrequency application. The structure in lilac is the coronary sinus. The blue point near the coronary sinus entrance shows the location where we measured the slow junctional rhythm. Additional regions where energy application 15 s did not induce slow junctional rhythm are marked in red. From the mapping, a flutter with a counterclockwise circuit dependent on the CTI with at the front of a depolarization wave is in orange for the septal region. Two block lines that abolished the arrhythmia were produced in red dots; one is from the coronary sinus to the CTI, and the other is at the CTI-level.

After ablation, the block line effectiveness was measured via septolateral and laterosseptal activation times longer than ms.

Heart Ablation Procedures | Abbott Cardiovascular

The evolution of electrophysiology diagnostic and therapeutic procedures has progressed in important ways in recent years. EAM systems have introduced new diagnostic and therapeutic potential for patients with complex arrhythmias.

The X-ray exposure time was lower in the group that concomitantly used EAM A group of 11 patients with accessory bundles on the right lateral wall who underwent unsuccessful ablation fluoroscopy then underwent a new EAM procedure, which was successful in each case Nine pregnant patients with supraventricular tachycardias that were not controlled through medication were ablated using EAM and minimal fluoroscopy time; the patients did not have recurrences following the procedure The fluoroscopy and EAM use yielded shorter radiation exposure times. However, the total procedure time, short and long-term success, complication rate and absence of symptoms were similar between the groups AFL ablation using fluoroscopy and EAM with fluoroscopy were compared in a randomized, multicenter clinical trial involving patients.

Both techniques were effective, but the fluoroscopy time was lower in the group using EAM at a higher cost Currently, the procedural complexity of arrhythmia ablation extends the exam times.

Catheter Ablation of Arrhythmias Exclusively Using Electroanatomic Mapping: A Series of Cases

Therefore, the fluoroscopy time is increased, which includes the inherent X-ray risks. EAM is used concomitantly in such tests to both assist in arrhythmia diagnosis and treatment as well as reduce the risks from radiation in procedures that involve fluoroscopy. In this study, we studied a series of patients who underwent an arrhythmia ablation exclusively using EAM. The results demonstrate this procedure can be performed with satisfactory results for both procedure time and success rate upon discharge.

Electrophysiological study and radiofrequency catheter ablation

Fluoroscopy was unnecessary for the EAM cases, and none of the patients had major complications. The catheters were positioned without complication. The distinction between catheters with different colors and greater than one projection view provides adequate spatial information during catheter positioning. For 4. For the mitral annulus accessory pathway, the ablation catheter passage through the aortic valve was easy to follow, and the shortest AV or VA intervals were identified as could be with conventional tests, without additional difficulty. However, our study has certain limitations.

It was designed as a case series study. The follow-up time is an additional limitation because the study results were only noted at discharge. Despite such limitations, we demonstrate that this procedure can be performed without fluoroscopy. EAM has introduced new therapeutic potential for arrhythmia patients. EAM is used to improve spatial orientation for the catheter in the heart and reduce the risks associated with radiation.

A randomized study that compares exclusive EAM and fluoroscopy use should provide more consistent data. This study is the first to demonstrate the feasibility of performing an ablation exclusively using EAM with satisfactory results. Left lateral bundle ablation during atrioventricular reentrant tachycardia.

The images on the left right anterior oblique view and right left anterior oblique view show catheter shadows used to identify the His bundle, coronary sinus and ablation catheter. The ablation catheter was introduced in a retrograde manner through the aorta.

Treating Arrhythmias with Cardiac Ablation

In brown are two early points where radiofrequency energy was applied for 10 s without arrhythmia termination. The point marked in red shows the location of the earliest VA signal during tachyarrhythmia, which was observed for the endocardial tracings below the figures. After 7. After this application, new induction was no longer possible. Extrasystole ablation from the right ventricle tract outflow. The images on the left left anterior oblique view and right right anterior oblique view show a map from a three-dimensional reconstruction of a right ventricular and catheter shadow for the His.

The earliest activity point observed in the extrasystole map was located in the lateral region of the right ventricle tract outflow. After the radiofrequency energy was applied, extrasystole was no longer observed red points. Potential Conflict of Interest.

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No potential conflict of interest relevant to this article was reported. Sources of Funding.

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Study Association. National Center for Biotechnology Information , U. Journal List Arq Bras Cardiol v. Arq Bras Cardiol. Author information Article notes Copyright and License information Disclaimer.