Rubén Laiño

Three-dimensional esophagus reconstruction and monitoring during ablation of atrial fibrillation: Combination of two imaging techniques

OBJECTIVE The purpose of the study was to determine the accuracy of a novel three-dimensional (3D) imaging integration technique of the esophagus combining multislice computed tomography (CT) scan of the esophagus into the three-dimensional (3D) electroanatomic map just before pulmonary vein (PV) isolation. METHODS We included 94 consecutive patients with symptomatic atrial fibrillation (AF) who underwent ablation. All patients had a CT performed prior procedure that was integrated to the 3D reconstruction electromechanical map of the atrium and the esophagus (Verismo(TM), EnSite® NavX version 7.0 J, St. Jude Medical Inc.). During the procedure, a quadripolar electrophysiology catheter placed in the esophagus was used for mapping and to monitor esophagus position. Integrated (fusion) images were used to determinate the esophagus position compared to the left atrium posterior wall and its relationship with PV ostiums. We compared esophagus position by CT and fusion images. RESULTS Procedural success was 97.9% with no fatal complications. Esophagus locations were as follows: left 57%, right 7%, oblique course 11% and central 25%. Agreements in esophageal position between CT and fusion imaging techniques were 83.3% and 64% for patients with a recent (≤48 h) and non-recent CT assessment (>48 h), respectively. Throughout the procedure, esophagus stability was 88.8% (lateral displacement<15 mm). Ablative strategy was modified in 51% of the cases due to awareness of esophagus location. CONCLUSION Guidance of AF ablation with 3D fusion images was safe and effective. CT images of the esophagus, especially if acquired within 48 h before ablation, ensure appropriate intraprocedural localization of the esophagus.

LONG-TERM INCIDENCE OF ATRIAL FIBRILLATION AFTER LONE PERSISTENT ATRIAL FLUTTER RADIOFREQUENCY ABLATION

Asrac Caeor: 16. Arrhhmias: AF/SVTreseaio Numer: 1239-274Auhors: Fernando Adrian Scazzuso, Santiago Rivera, Gaston Albina, Ruben Laino, Luis Gomez, Alberto Giniger, Instituto Cardiovascular de Buenos Aires(ICBA), Buenos Aires, ArgentinaBackground: Curre uielies esalishe cavoricusi ishmus (CTI) alaio as class I hera or recurre AFL. Neverheless a hih roorio o aies wih ical loe ersise Arial Fluer (AFL) have recurre eisoes o Arial Firillaio (AF). The aim o his su was o evaluae he resece o AF i aies uerwe CTI alaio wihou rior ocumee AF.Methods: 179 aies eliile or CTI alaio were iclue. rior hisor AF was assesse i 61 aies a eclue. CTI alaio was erorme i 118 remaii aies as escrie reviousl. aies ha mohl cliical ollow-u a 12-lea elecrocarioram or a miimum o ear. Ever 2 mohs a 48 Holer moior was erorme o eermie AF iciece aer CTI alaio aer a ear. Arial irillaio iaosis was eermie as a eisoe o more ha 30 secos. Aiarrhhmic rus were iscoiue aer roceure a aicoaulaio oe moh aer.Results: A oal o 118 aies (77.09% male; Ae 66 +/- 8 ears) were aalze. Biirecioal loc a he CTI was achieve i all a ies. A aie resee AF uri simulaio maeuvers or aer isoroereol amiisraio. Aer a ear AF was oserve i 85 aies (72%) uri he ollow u. Boh rous variales were aalze. Arial irillaio reicors aer CTI alaio were: Heresio ( = 0.003). Le arium area >23.3 cm2.Conclusions: CTI alaio i aies wih loe arial luer (AF) is o curaive as mos o he aies will evelo AF wihi a ear. Le arial area was he sro reicor or arial irillaio evelome i aies uerwe AFL alaio. Heresio ma e he ricial cause o LA elareme. os roceural aicoaulaio srae mus e revise ace o hese resuls a iall, i woul e wise o erorm oh CTI a LA alaio i aies resei wih loe AFL a le arium elareme. Furher rials ma hel o eie he eei o his sraey.

MAPEO ELECTROANATOMICO Y AISLAMIENTO DE VENA CAVA SUPERIOR EN UN PACIENTE CON FIBRILACION AURICULAR

Electroanatomic reconstruction of both atriums with En Site (Nav X) system during pulmonary veins isolation in a 47 years old patient with paroxistic atrial fibrillation. The polygraph shows the electrical activity registered by the circular catheter positioned in the superior vena cava, 3cm away from its origin. Superior Vena Cava disconnection is observed while catheter radiofrequency ablation is performed.