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. 2014 Jan;18(1):125-7.
doi: 10.1093/icvts/ivt433. Epub 2013 Oct 2.

Positioning of the ablation catheter in total endoscopic ablation

Anders Ahlsson  1 , Espen Fengsrud, Birger Axelsson
Affiliations

Positioning of the ablation catheter in total endoscopic ablation

Anders Ahlsson et al. Interact Cardiovasc Thorac Surg. 2014 Jan.

Abstract

Minimally invasive ablation of atrial fibrillation is an option in patients not suitable for or refractory to catheter ablation. Total endoscopic ablation can be performed via a monolateral approach, whereby a left atrial box lesion is created. If the ablation is introduced from the right side, the positioning of the ablation catheter on the partly hidden left pulmonary veins is of vital importance. Using thoracoscopy in combination with multiplane transoesophageal echocardiography, the anatomical position of the ablation catheter can be established. Our experience in over 60 procedures has confirmed this to be a safe technique of total endoscopic ablation.

Keywords: Ablation; Atrial fibrillation; Endoscopy; Left atrial appendage; Transoesophageal echocardiography.

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Figures

Figure 1:
Figure 1:
Computed tomography reconstruction of left atrium viewed from the left side showing left pulmonary veins and left atrial appendage (LAA). The yellow line indicates the correct position of the ablation catheter between the LAA and the left pulmonary veins. The red line depicts an incorrect position of the ablation catheter between the LAA and the atrioventricular groove overlying the left circumflex artery (CX).
Figure 2:
Figure 2:
(A). Thoracoscopic view of the transverse sinus showing the left atrial appendage (LAA), the superior caval vein (SVC) and the correct position of the ablation guide catheter below the LAA. (B). Transoesophageal echocardiographic view of the LAA, the left superior pulmonary vein (LSPV) and the mitral valve (MV). The red arrow indicates the ablation catheter correctly positioned between the LAA and the left superior pulmonary vein.
Supplementary Video 1:
Supplementary Video 1:
Thoracoscopic dissection below the superior caval vein into the transverse sinus showing the left atrial appendage and subsequently the inspection of the ablation guide in relation to the left atrial appendage.
Supplementary Video 2:
Supplementary Video 2:
Transoesophageal echocardiographic view of the left atrial appendage (LAA), the left superior pulmonary vein (LSPV) and the mitral valve (MV). By gently pulling the ablation catheter (AC), the movement of the catheter in the correct position can clearly be seen.
See this image and copyright information in PMC

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