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Sumi H, Hoshiyama T, Morihisa K, Noda K, Kaneko S, Kanazawa H, Ishii M, Fujisue K, Sueta D, Takashio S, Usuku H, Matsushita K, Tsujita K. Effect of contact vector direction on achieving cavotricuspid isthmus block. Sci Rep 2023; 13:2579. [PMID: 36781935 PMCID: PMC9925428 DOI: 10.1038/s41598-023-29738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Cavotricuspid isthmus (CTI) ablation is an important treatment strategy for CTI-dependent atrial flutter (AFL). The location of the catheter contact area is confirmed by the contact vector direction (CVD) through three-dimensional mapping during the procedure. However, the relationship between CVD during radiofrequency ablation and its efficacy in achieving CTI block has not been clarified. This study aimed to investigate the relationship between CVD and efficacy in achieving CTI block. CVDs during radiofrequency ablation were divided into proximal vectors against the distal tip (P-vector) and other vectors (normal-vector). In 39 patients who underwent CTI linear ablation, the CTIs were divided into two segments: the tricuspid valve area (anterior) and inferior vena cava area (posterior). The frequency of the residual conduction gap was compared between segments in which the P- and normal-vectors were observed. P-vectors were observed in 13 of the 78 segments. The median ablation index was not significantly different between segments in which the P-vector and normal-vector were observed (398.2 [384.2-402.2] vs. 393.3 [378.3-400.1], p = 0.15). However, residual conduction gaps were significantly more frequently observed in the segment in which the P-vector was observed than those in which only the normal-vector was observed (6/13, 46.2% vs. 3/65, 4.6%; p < 0.01). During a 6-month follow-up, two patients required a second session of ablation due to AFL recurrence. A residual conduction gap was observed in one patient at the site where the P-vector was observed in the first session. Avoiding the P-vector might be an important factor in improving CTI block and reducing AFL recurrence.
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Affiliation(s)
- Hitoshi Sumi
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Tadashi Hoshiyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan.
| | - Kenji Morihisa
- Kumamoto Chuo Hospital, 1-5-1, Tainoshima Minami-Ku, Kumamoto, 862-0965, Japan
| | - Katsuo Noda
- Kumamoto Chuo Hospital, 1-5-1, Tainoshima Minami-Ku, Kumamoto, 862-0965, Japan
| | - Shozo Kaneko
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Hisanori Kanazawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
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Hirata M, Nagashima K, Watanabe R, Wakamatsu Y, Otsuka N, Hayashida S, Hirata S, Sawada M, Kurokawa S, Okumura Y. Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch. J Arrhythm 2022; 38:1028-1034. [DOI: 10.1002/joa3.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Moyuru Hirata
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Naoto Otsuka
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Satoshi Hayashida
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Shu Hirata
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Masanaru Sawada
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
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Khakpour H, Mori S, Bradfield JS, Shivkumar K. How to Use Intracardiac Echocardiography to Recognize Normal Cardiac Anatomy. Card Electrophysiol Clin 2021; 13:273-283. [PMID: 33990266 DOI: 10.1016/j.ccep.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article reviews cardiac anatomy as it pertains to commonly used intracardiac echocardiography segments and views.
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Affiliation(s)
- Houman Khakpour
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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