Atlas of Radioscopic Catheter Placement for the Electrophysiologist (eBook)

Foreword 5
Foreword 6
Acknowledgements 7
Contents 8
Authors and Contributors 9
Part 1: Radiology 11
X-Ray Anatomy of the Heart 12
Computed Tomography of Anatomy of the Heart 17
2.1 CT Anatomy of the Heart 17
2.2 Multidetector Computerized Tomography 19
2.3 CT Study of Target Structures in Atrial Fibrillation Ablation 21
2.3.1 CT Study of Pulmonary Veins 22
2.3.2 CT Study of Left Atrium 25
2.3.3 Other Evaluations to Carry Out 29
2.4 Final Remarks 31
Part 2: Electropysiology 33
The Electrophysiologic Study 34
3.1 Diagnostic Catheters 34
3.2 Atrial Catheter 37
3.3 His Catheter 39
3.4 Right Ventricular Catheter: Apex and Outflow Tract 42
3.5 The Approach to the Coronary Sinus 48
Ablation of Supraventricular Tachycardias from the Right Atrium 61
4.1 Ablation Catheters 61
4.2 Atrioventricular Nodal Reentry Tachycardia 63
4.3 Atrioventricular Node’s Modulation and Ablation 67
4.4 Typical Atrial Flutter 69
Approach to the Left Heart Chambers 79
5.1 Transaortic or Retrograde Arterial Approach 79
5.2 Transseptal Approach 85
5.3 Utility of Intracardiac Echocardiographic Imaging 101
5.4 Double Transseptal Puncture 111
Accessory Pathways Ablation 118
6.1 Septal Accessory Pathways 120
6.2 Right-Sided Accessory Pathways 124
6.3 Left-Sided Accessory Pathways 127
Atrial Fibrillation Ablation 133
7.1 Pulmonary Vein Angiography 134
7.2 Pulmonary Vein Segmental Disconnection with Mapping Catheter 140
7.2.1 Mapping Catheters 140
7.2.2 Pulmonary Veins ’ Ostial Disconnection 150
7.3 Pulmonary Vein Circumferential Isolation 155
7.3.1 Electroanatomic Mapping Systems with Integration of Angio-CT/MRI Images 155
7.3.2 Left Atrial Mapping and Ablation 166
7.4 Linear Lesions: Left Mitral Isthmus and Roof 185
7.5 Superior Vena Cava Isolation 191
Ventricular Tachycardia Ablation 195
8.1 EnSite Catheter Positioning 196
8.2 Bundle Branch Reentrant Ventricular Tachycardia 203
8.3 Right Ventricular Outflow Tract Tachycardia 204
8.4 Left Ventricular Outflow Tract Tachycardias 206
8.5 Idiopathic Left Ventricle Tachycardias 212
8.6 Postischemic Ventricular Tachycardias 213
8.7 Epicardial Approach 219
Part 3: Pacing 223
Pacemaker and Implantable Cardioverter-Defibrillator Implantation 224
9.1 The Pacing Lead 224
9.2 Atrial Lead 224
9.3 Right Ventricular Lead 230
Biventricular Pacemaker and Implantable Cardioverter Defibrillator 238
10.1 Anatomy of the Coronary Sinus 238
10.2 Equipment for Coronary Sinus Cannulation: Guiding Sheaths 241
10.3 Coronary Sinus Cannulation Techniques 244
10.4 Coronary Sinus Angiography 248
10.5 Devices for Positioning the Left Ventricular Lead 250
10.5.1 Guidewires and Stylets 250
10.5.2 Leads for Coronary Sinus 251
10.6 Positioning Techniques of the Left Ventricular Lead 253
Pacemaker and Implantable Cardioverter Defibrillator Lead Extraction 268
11.1 Introduction 268
11.2 Extraction Techniques 269
11.2.1 Traction 269
11.2.2 Traction and Countertraction with Locking Stylets and Telescoping Synthetic Sheaths 270
11.2.3 Electrosurgical Dissection System 274
11.2.4 Laser Lead Extraction 276
11.2.5 Transfemoral or Transjugular Approach 283
11.3 Conclusions 287
Part 4: Endomyocardial Biopsy 290
Endomyocardial Biopsy 291
12.1 Biopsy Technique 292
12.1.1 Femoral Approach with Preformed Sheath and Flexible Bioptome 292
Right Ventricular Endomyocardial Biopsy 292
Left Ventricular Endomyocardial Biopsy 297
12.1.2 Preshaped Bioptome 297
12.2 Indications to Endomyocardial Biopsy 299
12.3 Endomyocardial Biopsy in Patients with Arrhythmias 300
12.4 Tissue Processing and Analysis 302
Bibliography 304
Index 311