Biventricular Device Implantation

Asirvatham, Samuel J.

doi:10.1002/9780470757727.ch4

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…When a deep pouch is seen, almost always a large and prominent Thebesian valve is also seen. This fact is important for left ventricular lead implanters as well as electrophysiologists, as a prominent Thebesian valve may make cannulation of the CS difficult, but, more importantly, the coexisting pouch will cause difficulty with stable placement of preformed guiding sheaths 17,18 …”

Section: Anatomic Basis For Difficulty With Cvti Ablationmentioning

confidence: 99%

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Correlative Anatomy and Electrophysiology for the Interventional Electrophysiologist:

Asirvatham

2008

Cardiovasc electrophysiol

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The cavotricuspid isthmus (CVTI) is the well-established location of atrial tissue critical for the maintenance of typical atrial flutter. The CVTI begins at the electrically inert tricuspid valve and includes the atrial myocardium up to the inferior vena cava (IVC). In this article, we discuss relevant CVTI and right atrial anatomy of interest to the electrophysiologist. Critical questions that are considered include why ablation is sometimes difficult across the CVTI and how best to deal with anatomic variation including sub-Eustachian pouches or large pectinate muscles encroaching onto the isthmus. Important electroanatomic features of the right atrium (RA) including sites for naturally occurring conduction block and the anatomy of the "lower loop" are reviewed. Following this discussion on the impact of the underlying anatomy for right atrial flutter ablation, an approach to dealing with difficulty when mapping or ablating this common arrhythmia is presented.

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Section: Anatomic Basis For Difficulty With Cvti Ablationmentioning

confidence: 99%

“…The ER itself is often partly or largely fibrous tissue and much ablation may not be required directly on this structure. The usual difficulty caused by a prominent ER is with catheter manipulation and contact 13,17,21 …”

Section: Anatomic Basis For Difficulty With Cvti Ablationmentioning

confidence: 99%

Correlative Anatomy and Electrophysiology for the Interventional Electrophysiologist:

Asirvatham

2008

Cardiovasc electrophysiol

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The Buddy Wire Technique: Accessing Lateral Coronary Veins While Maintaining Coronary Sinus Position

Perzanowski

Gilliam

2005

J Interv Card Electrophysiol

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There is compelling data to place the coronary sinus lead (CSL) in a lateral or posterolateral tributary. Coronary sinus venography often demonstrates the absence of easily accessible lateral veins or those with sufficient size to accommodate the CSL. The operator may choose to deploy the CSL in the anterior vein but publications and experience highlight the lack of resynchronization benefit when the CSL is deployed in this location. There is often a posterolateral vessel or the middle cardiac vein (MCV) originating from near the coronary sinus (CS) os. These vessels require the operator to pull the CS guide essentially out of the CS to allow successful access. Cannulation of the coronary sinus (CS) is often challenging, and the risk of losing access to the CS may dissuade the implanter from attempting access to a vessel near the CS os. We describe a technique to access vessels near the CS os while maintaining secure position in the main body of the CS.

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Innovation Focus: the Patient with Arrhythmia

Asirvatham

2008

J. of Cardiovasc. Trans. Res.

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Great strides have been made over the last two decades in the management of patients with rhythm disorders. Despite this, however, the remaining critical problems of stroke related to atrial fibrillation or as a result of radiofrequency ablation require innovative solutions to fully realize the potential of these recent advances. Similarly, implanted cardiac devices have revolutionized the care of patients with bradyrhythmias and tachyarrhythmias. Dyssynchronus ventricular pacing associated with present devices; however, results in heart failure, tricuspid regurgitation, and inappropriate device therapy once again create a demand for creative solutions. While not technically an arrhythmia, epilepsy management today is riddled with many of the problems that plagued cardiac arrhythmia management previously, and thus an appreciation of the similarities in requirement for investigative solutions may yield groundbreaking solutions. In this paper, we describe some novel methods to reduce complications associated with rhythm disorders and their treatment and apply the lessons learned from cardiovascular arrhythmia management to the brain. These include: a method to reduce coagulum formation and thus subsequent thromboembolism with indwelling catheters specifically during radiofrequency ablation procedures; a technique to ligate the left atrial appendage through percutaneous subxiphoid pericardial access; development and testing of a novel intramyocardial pace-sense lead, particularly used in a unique anatomic location (the atrioventricular septum) to allow pacing the ventricles in a relatively synchronous manner without crossing the tricuspid valve or entering the coronary sinus; finally, novel modifications of the cardiovascular mapping and ablation techniques used for the management of the central nervous system disorders primarily via the venous drainage of the brain. Innovative and potential solutions to treat the patient with arrhythmia are presented.

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Biventricular Device Implantation

Cited by 4 publications

References 22 publications

Correlative Anatomy and Electrophysiology for the Interventional Electrophysiologist:

Correlative Anatomy and Electrophysiology for the Interventional Electrophysiologist:

The Buddy Wire Technique: Accessing Lateral Coronary Veins While Maintaining Coronary Sinus Position

Innovation Focus: the Patient with Arrhythmia

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