Image Integration of Coronary Cine‐Angiography with 3D Electroanatomic Mapping Using CartoUnivu for Left Coronary Cusp Ventricular Tachycardia

Abstract

cardiac mapping, electrophysiology, three-dimensional systems, ventricular tachycardiaA 16-year-old female with a history of tachycardia-induced dilated cardiomyopathy (left ventricular ejection fraction 32%) underwent catheter ablation. Baseline electrocardiogram demonstrated ventricular tachycardia (VT) with a left bundle branch block pattern and an inferior axis (Fig. 1), which was likewise observed during electrophysiology study. Three-dimensional (3D) electroanatomic mapping was performed using the CARTO 3 System (Biosense Webster, Diamond Bar, CA, USA). Detailed mapping identified local electrograms preceding the ectopic QRS complex by 56 milliseconds and with a 12/12 lead pace-map match within the left coronary cusp. Selective left main coronary artery (LMCA) angiography was performed at

Idiopathic Ventricular Arrhythmia Ablation Using Non-Fluoroscopic Catheter Visualization System

“…CartoUnivu (Biosense Webstar) is another module that can integrate electroanatomic mapping into fluoroscopic imaging, demonstrating feasible outcomes for various types of arrhythmia, 23) including VT. 24) Lau, et al recently reported a case of successful ASV origin VT ablation using the system. 25) Although the procedure, fluoroscopy times, and radiation doses were not provided in the report, their workflow seemed very similar to our NFCV procedure. Both systems allow minimal radiation exposure without much alteration of the conventional workflow.…”

Ablation with zero‐fluoroscopy of premature ventricular complexes from aortic sinus cusps: A single‐center experience

“…This approach was found to provide various advantages, includ- ASC-PVC ablations have been reported to represent 16% of ablations in outflow tracts. 10 As noted above, CC has conventionally been used to ensure a safe distance (>5 mm) between ablation catheter tip and CAO. 1 However, the catheterization must be repeated if the ablation catheter is repositioned during CC, and the integration of catheterization in mapping systems has been proposed to overcome this drawback.…”

“…1 However, the catheterization must be repeated if the ablation catheter is repositioned during CC, and the integration of catheterization in mapping systems has been proposed to overcome this drawback. 10 Nevertheless, lesser precision is obtained with closer proximity to the CAO, and another CC with new mapping system integration is required when the ablation catheter is repositioned, as reported in 25% of the patients studied by Jularic et al 11 Transesophageal echocardiography has been proposed as an alternative approach but has only been described in a few isolated cases. 12 In addition, contrast injection through the ablation catheter has been proposed as a tool to visualize CAO, but the low flow of injected contrast limits the accuracy of CAO distance estimations.…”

“… 1 However, the catheterization must be repeated if the ablation catheter is repositioned during CC, and the integration of catheterization in mapping systems has been proposed to overcome this drawback. 10 Nevertheless, lesser precision is obtained with closer proximity to the CAO, and another CC with new mapping system integration is required when the ablation catheter is repositioned, as reported in 25% of the patients studied by Jularic et al 11 …”

Selective Angiography Using the Radiofrequency Catheter: An Alternative Technique for Mapping and Ablation in the Aortic Cusps

“…If CA is performed it is important to acknowledge that, in case catheter repositioning is needed to continue mapping after failed ablation, repeated CA is necessary to assess real‐time relation of catheter tip and the coronary ostium. To avoid repeated CA, it has been proposed to integrate CA with the mapping system but in aortic cusps area only a single case report has been published. Finally, cryoablation has been reported as a safer energy source to avoid coronary damage in a short case series, but in all patients CA was performed before ablation and no large series or randomized trials have been published.…”