Intracardiac echocardiography to guide transseptal catheterization for radiofrequency catheter ablation of left-sided accessory pathways: two case reports.
Intracardiac echocardiography (ICE) is a useful tool for guiding transseptal puncture during electrophysiological mapping and ablation procedures. Left-sided accessory pathways (LSAP) can be ablated by using two different modalities: retrograde approach through the aortic valve and transseptal approach with puncture of the fossa ovalis. We shall report two cases of LSAP where transcatheter radiofrequency ablation (TCRFA) was firstly attempted via transaortic approach with ineffective results. Subsequently, a transseptal approach under ICE guidance has been performed. During atrial septal puncture ICE was able to locate the needle tip position precisely and provided a clear visualization of the "tenting effect" on the fossa ovalis. ICE allowed a better mapping of the mitral ring and a more effective catheter ablation manipulation and tip contact which resulted in a persistent and complete ablation of the accessory pathway with a shorter time of fluoroscopic exposure. ICE-guided transseptal approach might be a promising modality for TCRFA of LSAP.
Department of Cardiology, San Luca Hospital, Vallo della Lucania, Salerno, Italy. citro63@libero.it
Rodolfo
R
Citro
Valentino
V
Ducceschi
Alessandro
A
Salustri
Michele
M
Santoro
Michele
M
Salierno
Giovanni
G
Gregorio
D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000000981:diagnostic imaging* / Q000601:surgery*; D006352:Heart Ventricles / Q000294:innervation / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D013617:Tachycardia, Supraventricular / Q000601:surgery*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*