Elsevier

Canadian Journal of Cardiology

Volume 29, Issue 2, February 2013, Pages 254.e9-254.e11
Canadian Journal of Cardiology

Case report
Nonfluoroscopic Catheter Ablation of a Double-Loop Re-entry Tachycardia Guided by Real-Time Contact Force Information

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Abstract

Nonfluoroscopic catheter ablation has been demonstrated for typical arrhythmias. It is important to note that insufficient contact force may result in an ineffective lesion, whereas excessive contact force may result in complications. Herein, we demonstrate nonfluoroscopic mapping and ablation of a cavotricuspid isthmus–dependent double-loop re-entry tachycardia guided by real-time contact force information. Periprocedural delayed-enhancement magnetic resonance imaging supported the presence of the ablation lesion without any other evidence of a scar substrate for this arrhythmia.

Résumé

L'ablation par cathéter sans fluoroscopie a été démontrée dans les arythmies typiques. Il est important de noter qu'une force de contact insuffisante peut entraîner une lésion inefficace tandis qu'une force de contact excessive peut entraîner des complications. Dans cet article, nous démontrons la cartographie et l'ablation sans fluoroscopie d'une tachycardie par réentrée à double boucle dépendante de l'isthme cavotricuspide guidée par la force de contact en temps réel. L'imagerie par résonance magnétique de rehaussement tardif périopératoire confirmait la présence de la lésion ablative sans aucun autre signe de substrat cicatriciel de cette arythmie.

Section snippets

Case Report

A man aged 58 years was referred to our electrophysiology labouratory for radiofrequency catheter ablation of an incessant narrow QRS-complex tachycardia suggesting an atypical atrial macro–re-entry tachycardia (Fig. 1).

Characterization of the arrhythmia was performed without the use of fluoroscopy under the guidance of a 3-dimensional electroanatomic mapping system (CARTO-3; Biosense-Webster, Diamond, CA), in combination with a catheter with integrated contact force sensor. A 3.5-mm

Discussion

Nonfluoroscopic catheter ablation has been demonstrated in the majority of typical arrhythmias by use of the Ensite-NavX system.1, 2 Several approaches that use radiofrequency or cryoablation seem to be safe and feasible, as demonstrated in a limited number of patients. In particular, cavotricuspid isthmus ablation has already been used successfully as a first-line therapy.3 However, insufficient contact force may result in an ineffective lesion in some patients, whereas excessive contact force

Funding Sources

C.M. received support as a fellow of the European Heart Rhythm Association for the 1-year fellowship (advanced program) in interventional electrophysiology (mentor: Prof Helmut Purerfellner). C.M. is also the recipient of a research grant from the Hans-und-Gertie-Fischer Stiftung.

Disclosures

The authors have no conflicts of interest to disclose.

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