Friday, January 10, 2014

Case Study: Mitral Annular Left Atrial Flutter

Sometimes what we do is just cool.

Cardiac electrophysiology has amazing technology at its disposal. One of these is three dimensional mapping. While three-dimensional mapping is not always required to perform catheter ablation, it can be invaluable when mapping and ablating forms of post-surgical atypical atrial flutter. The video below shows one such case we performed with the three-dimensional mapping system from Endocardial Solutions.

This system uses an X/Y/Z coordinate system created by referencing impedance changes that occur between paired electrodes placed on the patient's chest. Moving a single mapping catheter inside the left atrium during the patient's tachycardia permits localization of both the ablation catheter and the signal recorded.  An "activation map" from approximately 200 different points (the tiny white dots) that we collected in patient's left atrium is displayed below. The low amplitude signals (less than 0.5 mV) were colored grey. The map had the area of the mitral valve "cut away" using software so the endocardial surface could be better seen.

In this map, endocardial activation proceeds in a clockwise fashion and slows ever-so-slightly in the posterolateral mitral annulus near the blue dot. A single radiofrequency energy application at this location immediately terminated the patient's incessant left atrial flutter.

I love my job.


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