Hands On
How to use intracardiac echocardiography to guide catheter ablation of outflow tract ventricular arrhythmias
The anatomy of the ventricular outflow tracts and semilunar valves as it pertains to catheter ablation of outflow tract ventricular arrhythmias (OTVAs) has been described.1 Assessment of semilunar valve and regional anatomy by fluoroscopy and angiography has limitations. Coronary arteries may be subject to damage from catheter ablation near the semilunar valves due to their proximity to sites of origin of OTVAs. Detailed intracardiac echocardiographic (ICE) views of the semilunar valves may be useful to understand the anatomy, catheter location, and coronary artery proximity and variations.How to map and ablate papillary muscle ventricular arrhythmias
The papillary muscles (PMs) are a source of ventricular arrhythmias (VAs) in both structurally normal and abnormal hearts. Presentation includes isolated premature ventricular contractions (PVCs), nonsustained ventricular tachycardia (VT), and sustained recurrent VT. In addition, PVCs arising from the PMs may play a role as triggers of ventricular fibrillation (VF).1,2 Because of their highly variable and complex anatomy and independent motion during the cardiac cycle, catheter ablation is challenging, with lower procedural success and higher recurrence rates compared with other locations.How to map and ablate left ventricular summit arrhythmias
Catheter ablation of idiopathic ventricular arrhythmias (VAs) is highly successful, with overall cure rates >90%, and is accepted as a first-line therapy by current guidelines.1 However, despite the advances in mapping and ablation techniques, there is a percentage of patients in whom successful ablation cannot be achieved because of anatomic limitations. In this regard, one of the most challenging clinical problems that electrophysiologists may face in the laboratory is the approach to VAs arising from the summit of the left ventricle (LV).
