The Clinical Cardiac Electrophysiology Handbook by Jason Andrade Matthew Bennett Marc Deyell

Author:Jason Andrade,Matthew Bennett,Marc Deyell
Language: eng
Format: epub
Publisher: National Book Network International

Ablation Target

○The procedure is commenced by advancing the ablation catheter across the TV.

○The catheter is deflected to the RA floor and withdrawn until the bipolar signal exhibits a dominant V with a small A (distal position).

▪ During sinus rhythm, the ideal catheter orientation is at approximately 6 o’clock when in an LAO angle of 45°.

• Anterolateral (beyond 7 o’clock) is difficult as the isthmus myocardium is broader, longer and thicker.

• Septal (beyond 5 o’clock) confers a risk of an AV block (due to AV nodal artery damage) and myocardial infarction (due to inadvertent ablation in the middle cardiac vein).

▪ During a counterclockwise flutter, the ideal catheter orientation is where the local activation activates in the middle of the plateau on the surface ECG (i.e., is within the area of slow conduction).

○The RF application for 45–60 seconds is performed until the atrial (A) EGM has diminished.

○The catheter is then slightly withdrawn towards the IVC until a fresh set of EGMs are observed, and ablation is reapplied.

▪ Progressive catheter withdrawal results in atrial (A) EGM dominance with the disappearance of ventricular (V) EGM, followed by loss of local EGMs once the IVC is reached.

Proximal Position

Large A:V EGM ratio Distal Position

Small A:V EGM ratio

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