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Selective Angiography Using the Radiofrequency Catheter: An Alternative Technique for Mapping and Ablation in the
Ivo Roca-Luque1, Nuria Rivas1, Jaume Francisco1
1Electrophysiology and Arrhythmia Unit, Barcelona, Spain.
Insights
Selective angiography using an ablation catheter safely assesses coronary ostia proximity during aortic cusp ablation, avoiding extra procedures and risks.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Aortic cusp ablation is needed for certain arrhythmias, posing a risk of coronary artery damage.
- Current imaging methods like coronary angiography (CA), intravascular (ICE), and transesophageal echocardiography (TEE) have limitations, including additional vascular access or repeat CA.
- A need exists for a safer, more efficient method to monitor catheter position relative to coronary ostia during aortic cusp ablation.
Purpose of the Study:
- To evaluate the feasibility and safety of selective angiography through the ablation catheter.
- To assess the relationship between the catheter tip and coronary ostia during aortic cusp ablation.
- To determine if this method can replace or supplement existing imaging techniques.
Main Methods:
- Prospective evaluation of 12 patients undergoing ablation in aortic cusps.
- Selective angiography performed using a cooled-tip radiofrequency ablation catheter at the ablation site.
- Monitoring of catheter tip position relative to coronary ostia in real-time.
Main Results:
- Ablation was effective in 91.6% of patients.
- No complications occurred during the procedure or follow-up.
- No technical issues arose with the ablation catheter during contrast injection.
Conclusions:
- Selective angiography via a cooled-tip ablation catheter is a feasible method for assessing proximity to coronary ostia during aortic cusp ablation.
- This technique allows continuous, real-time assessment, avoids additional vascular access, and proved safe in this patient series.
- It offers a valuable alternative to conventional imaging methods for this specific ablation procedure.
Background:
Ablation in aortic cusps could be necessary in up to 15% of the patients, especially in para-Hisian atrial tachycardia and ventricular arrhythmias arising from outflow tracts. Risk of coronary damage has led to recommendation of systematic coronary angiography (CA) during the procedure. Other image tests as intravascular (ICE) or transesophageal echocardiography (TEE) have been proposed. Both methods have limitations: additional vascular access for ICE and need for additional CA in some patients in case of TEE. We describe an alternative method to assess relation of catheter tip and coronary ostia during ablation in aortic cusps without additional vascular accesses by performing selective angiography with the ablation catheter.
Methods And Results:
We prospectively evaluated 12 consecutive patients (69.3 ± 8.5, 6 female) who underwent ablation in right (1), left (5), and noncoronary cusps (6). We performed angiography through the ablation cooled tip radiofrequency catheter at the ablation site. Ablation was effective in 91.6% of the patients (3 patients needed additional ablation out of coronary cusps: pulmonary cusp, right ventricular outflow tract (RVOT), and coronary sinus and 1 patient underwent a second procedure because recurrence). No complications occurred neither during procedure nor follow-up (6.2 ± 3.8 months). No technical problems occurred with the ablation catheter after contrast injection.
Conclusion:
Selective angiography through a cooled-tip radiofrequency ablation catheter is feasible to assess relation of coronary ostia and ablation site when ablation in aortic cusps. It allows continuous real-time assessment of this relation, avoids the need for additional vascular accesses and no complications occurred in our series.
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