Interv Akut Kardiol. 2006;5(6):246-249
CAVOTRICUSPID ISTHMUS MORPHOLOGY DEFINED BY INTRACARDIAC ULTRASOUND
- Klinika kardiologie, Institut klinické a experimentální medicíny, Praha
Introduction: Catheter ablation across the cavotricuspid (CT) isthmus is a highly effective treatment of typical atrial flutter. However, creation of isthmus block is sometimes difficult due to the presence of excavation and ridges within the isthmus. The goal of our study was to describe the variability of CT isthmus morphology using intracardiac echocardiography(ICE, Accuson Sequoia, Siemens).
Methods: The study population includes 30 patients (mean age 52 ± 10years), in which the ICE was used during ablation of supraventricular arrhythmias in our laboratory. The ICE was used to assess: 1. CT isthmus width, 2. morphology and 3. catheter stability.
Results: Mean end-diastolic and end-systolic width of the CT isthmus was 34 ± 6mm and 25 ± 7mm, respectively. The portion of the isthmus adjacent to the tricuspid isthmus was smooth without excavation in all patients. However, in patients with wide isthmus the catheter had lower stability within this region. In the middle portion of the isthmus was found an excavation in 4 patients (13 %). Additional 7 patients (23 %) had prominent Eustachian ridge (more than 5mm) that made it difficult to reach the part of the isthmus adjacent to the inferior vena cava.
Conclusion: The ICE enables detailed visualization of CT isthmus morphology together with the location and stability of the ablation catheter. In selected patients with complex isthmus anatomy the use of ICE may be of advantage, especially for electrophysiologists in training.
Keywords: Key words: catheter ablation, atrial flutter, intracardiac echocardiography.
Published: February 1, 2007 Show citation
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