title: Selective Angiography Using the Radiofrequency Catheter: An Alternative Technique for Mapping and Ablation in the Aortic Cusps.
abstract: Ablation in aortic cusps could be necessary in up to 15% of the patients, especially in para-Hisian atrial tachycardia and ventricular arrhythmias arising from outflow tracts. Risk of coronary damage has led to recommendation of systematic coronary angiography (CA) during the procedure. Other image tests as intravascular (ICE) or transesophageal echocardiography (TEE) have been proposed. Both methods have limitations: additional vascular access for ICE and need for additional CA in some patients in case of TEE. We describe an alternative method to assess relation of catheter tip and coronary ostia during ablation in aortic cusps without additional vascular accesses by performing selective angiography with the ablation catheter.
  
  
  
  We prospectively evaluated 12 consecutive patients (69.3 ± 8.5, 6 female) who underwent ablation in right (1), left (5), and noncoronary cusps (6). We performed angiography through the ablation cooled tip radiofrequency catheter at the ablation site. Ablation was effective in 91.6% of the patients (3 patients needed additional ablation out of coronary cusps: pulmonary cusp, right ventricular outflow tract (RVOT), and coronary sinus and 1 patient underwent a second procedure because recurrence). No complications occurred neither during procedure nor follow-up (6.2 ± 3.8 months). No technical problems occurred with the ablation catheter after contrast injection.
  
  
  
  Selective angiography through a cooled-tip radiofrequency ablation catheter is feasible to assess relation of coronary ostia and ablation site when ablation in aortic cusps. It allows continuous real-time assessment of this relation, avoids the need for additional vascular accesses and no complications occurred in our series.
authors.affiliation: Electrophysiology and Arrhythmia Unit, Barcelona, Spain.
authors.forename: Ivo
authors.initials: I
authors.lastname: Roca-Luque
authors.affiliation: Electrophysiology and Arrhythmia Unit, Barcelona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Rivas
authors.affiliation: Electrophysiology and Arrhythmia Unit, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Francisco
authors.affiliation: Electrophysiology and Arrhythmia Unit, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Perez
authors.affiliation: Electrophysiology and Arrhythmia Unit, Barcelona, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Acosta
authors.affiliation: Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Gerard
authors.initials: G
authors.lastname: Oristrell
authors.affiliation: Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Terricabres
authors.affiliation: Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Garcia-Dorado
authors.affiliation: Electrophysiology and Arrhythmia Unit, Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Moya
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000295:instrumentation*; D017023:Coronary Angiography / Q000295:instrumentation*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies
keywords: aortic cusps; atrial tachycardia; coronary damage; irrigated tip catheter; selective angiography; ventricular tachycardia