Intracardiac Echocardiography in Premature Ventricular Complex/Ventricular Tachycardia Ablation

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Intracardiac Echocardiography in Premature Ventricular Complex/Ventricular Tachycardia Ablation Tae-Seok Kim Sung-Hwan Kim ECG & EP CASES Tae-Seok Kim, MD, Sung-Hwan Kim, MD Department of Internal

Mary s Hospital Intracardiac echocardiography in premature ventricular complex/ventricular tachycardia ablation ABSTRACT Although fluoroscopy is the most commonly used imaging tool for guiding

1 Intracardiac Echocardiography in Premature Ventricular Complex/Ventricular Tachycardia Ablation Tae-Seok Kim Sung-Hwan Kim ECG & EP CASES Tae-Seok Kim, MD, Sung-Hwan Kim, MD Department of Internal Medicine, Catholic University of Korea, Seoul St. Mary s Hospital Intracardiac echocardiography in premature ventricular complex/ventricular tachycardia ablation ABSTRACT Although fluoroscopy is the most commonly used imaging tool for guiding catheter ablation, there are several associated limitations, including radiation exposure, poor resolution of soft-tissue structures, and the use of iodinated contrast agents. In contrast, intracardiac echocardiography (ICE) can provide excellent realtime and detailed images, thus facilitating a more efficient catheter ablation. Moreover, ICE is useful in premature ventricular complex/ventricular tachycardia ablation because it can provide information on catheter contact and complicated anatomical structures, such as the papillary muscle. Key words: arrhythmia catheter ablation intracardiac echocardiography Received: May 22, 2013 Accepted: June 30, 2013 Correspondence: Sung-Hwan Kim, MD. Division of Cardiology, Department of Internal Medicine, Seoul St. Mary s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Korea Tel: , Fax: sunghwan@catholic.ac.kr VOL.14 NO.2 29

2 Figure 1. Surface electrocardiogram of Case #1. Figure 2. Ablation around the left ventricular scar with the CARTO mapping system. 30 The Official Journal of Korean Heart Rhythm Society

3 Figure 3. Intracardiac echocardiography indicating the papillary muscle and the ablation catheter. VOL.14 NO.2 31

Ventricular With the constant increase in the number of arrhythmias are associated with complex cardiac individuals experiencing heart failure and the structures, for which the ablation approach

4 ECG & EP CASES Figure 4. Surface electrocardiogram of Case #2. Figure 5. Intracardiac echocardiography: a short-axis view at the aortic root level. therapy as a first-line therapy to patients with Discussion symptomatic ventricular arrhythmias. Ventricular With the constant increase in the number of arrhythmias are associated with complex cardiac individuals experiencing heart failure and the structures, for which the ablation approach depends increased longevity of individuals with coronary on the associated anatomy. The development of ICE artery disease, ventricular arrhythmias have become was facilitated by the miniaturization of ultrasound a common clinical problem. Catheter ablation can be transducers that are mounted on flexible and offered as an alternative to antiarrhythmic drug relatively thin catheters, which can be advanced and 5 32 The Official Journal of Korean Heart Rhythm Society

5 Figure 6. Intracardiac echocardiography showing noncontact of the ablation catheter. Figure 7. Intracardiac echocardiography showing good contact of the ablation catheter. VOL.14 NO.2 33

6 References 1. West JJ, Norton PT, Kramer CM, Moorman JR, Mahapatra S, DiMarco JP, Mangrum JM, Mounsey JP, Ferguson JD. Characterization of the mitral isthmus for atrial fibrillation ablation using intracardiac ultrasound from within the coronary sinus. Heart rhythm. 2008;5: Jongbloed MR, Bax JJ, van der Burg AE, Van der Wall EE, Schalij MJ. Radiofrequency catheter ablation of ventricular tachycardia guided by intracardiac echocardiography. Eur J Echocardiogr. 2004;5: Lamberti F, Calo L, Pandozi C, Castro A, Loricchio ML, Boggi A, Toscano S, Ricci R, Drago F, Santini M. Radiofrequency catheter ablation of idiopathic left ventricular outflow tract tachycardia: Utility of intracardiac echocardiography. J Cardiovasc Electrophysiol. 2001;12: Vaseghi M, Cesario DA, Mahajan A, Wiener I, Boyle NG, Fishbein MC, Horowitz BN, Shivkumar K. Catheter ablation of right ventricular outflow tract tachycardia: Value of defining coronary anatomy. J Cardiovasc Electrophysiol. 2006;17: Reddy VY, Reynolds MR, Neuzil P, Richardson AW, Taborsky M, Jongnarangsin K, Kralovec S, Sediva L, Ruskin JN, Josephson ME. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med. 2007;357(26): Kim, S. S., Hijazi, Z. M., Lang, R. M., & Knight, B. P. The use of intracardiac echocardiography and other intracardiac imaging tools to guide noncoronary cardiac interventions. J Am Coll Cardiol. 2009;53(23): The Official Journal of Korean Heart Rhythm Society

Radiofrequency catheter ablation of ventricular tachycardia guided by intracardiac echocardiography

Eur J Echocardiography (2004) 5, 34e40 Radiofrequency catheter ablation of ventricular tachycardia guided by intracardiac echocardiography M.R.M. Jongbloed, J.J. Bax), A.E. Borger van der Burg, E.E. Van