Vinod Jayam

Radiation Exposure During Catheter Ablation of Atrial Fibrillation

Background—The purpose of this study was to determine the radiation exposure during catheter ablation of atrial fibrillation (AF) using the pulmonary vein (PV) approach. Methods and Results—The study included 15 patients with AF and 5 patients each with atrial flutter and atrioventricular nodal reentrant tachycardia (AVNRT) who underwent fluoroscopically guided procedures on a biplane x-ray system operated at a low-frame pulsed fluoroscopy (7.5 frames per second). Radiation exposure was measured directly with 50 to 60 thermoluminescent dosimeters (TLDs). Peak skin doses (PSDs), effective radiation doses, and risk of fatal malignancies were all computed. Mean fluoroscopy durations for AF procedures were 67.8±21 minutes in the right anterior oblique (RAO) and 61.9±16.6 minutes in the left anterior oblique (LAO) projection, significantly different from that required for atrial flutter and AVNRT. The mean PSDs measured with the TLDs were 1.0±0.5 Gy in the RAO and 1.5±0.4 Gy in the LAO projection. The lifetime risk of excess fatal malignancies normalized to 60 minutes of fluoroscopy was 0.07% for women and 0.1% for men. Conclusions—The relatively small amounts of the patient’s radiation exposure in this study, despite the prolonged fluoroscopy durations, can be attributed to the use of very-low-frame pulsed fluoroscopy, the avoidance of magnification, and optimal adjustments of the fluoroscopy exposure rates. The resulting lifetime risk of fatal malignancy is within the range previously reported for standard supraventricular arrhythmias.

Predictors of Recurrence Following Catheter Ablation of Atrial Fibrillation Using an Irrigated‐Tip Ablation Catheter

Introduction: The aims of this study were to identify predictors of recurrence after catheter ablation of atrial fibrillation (AF) and to report the safety and efficacy of catheter ablation of AF using an irrigated‐tip ablation catheter.

Characterization of a new pulmonary vein variant using magnetic resonance angiography: incidence, imaging, and interventional implications of the "right top pulmonary vein".

Introduction: Catheter ablation of the pulmonary veins (PVs) for prevention of recurrent atrial fibrillation requires precise anatomic information. We describe the characteristics of a new anatomic variant of PV anatomy using magnetic resonance angiography.

Electrical disconnection of the superior vena cava from the right atrium

A 39-year-old man presented with a 2-year history of frequent, symptomatic, paroxysmal atrial fibrillation (AF). After not responding to multiple antiarrhythmic drugs, he underwent a successful pulmonary vein (PV) isolation procedure. His symptoms resolved for a few weeks but then recurred. A second ablation procedure was performed 6 months later. Mapping of the PVs demonstrated their continued isolation. Mapping of the superior vena cava (SVC) in conjunction with the second ablation procedure using a 64-pole basket catheter showed active SVC potentials. The left panel of the figure shows bipolar electrograms recorded from the electrodes (numbered 1–8) on the eight spines (labeled A–H) of the 64-pole basket catheter. Application of RF energy to a single site in the low posterior SVC wall (orthogonal fluoroscopic images in the right panel; CS = coronary sinus)