Ablation in Adult Congenital Heart Disease Using a Dual-Energy, Lattice-Tip, Large-Footprint, Map-and-Ablate Catheter

Figures

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  Figure 1. Findings on ECG and Initial Ablation Procedure in Case 1 (A) 12-lead ECG of clinical tachycardia. (B) Anteroposterior view showing the Sphere-9 catheter in the right superior pulmonary vein and the decapolar catheter in the coronary sinus. (C) Posteroanterior view showing pulmonary vein isolation using PFA (green dots). (D) Three-dimensional reconstruction of cardiac anatomy from computed tomography angiography. ECG = electrocardiogram; Os = ostium; PFA = pulsed-field ablation; RSPV = right superior pulmonary vein.

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  Figure 2. Second Ablation Procedure in Case 1 (A) Posteroanterior view of the systemic venous atrium showing low-voltage areas on the posterior septum. The region of the sinus atrial node (SAN) is tagged. (B) Radiofrequency ablation line with lesions connecting the superior vena cava to the scar, and covering the scarred septum. (C) Posterior view showing reconnected left vein and a narrow channel of healthy tissue on the posterior pulmonary venous atrium. (D) Activation map demonstrating roof-dependent flutter (arrows indicate direction of wavefront). (E) Posterior view showing PFA lesions (roof line and pulmonary vein isolation of left veins). (F) Anterior view showing combined lesion sets for systemic and pulmonary venous atria. LA = left atrial; Os = ostium; PFA = pulsed-field ablation; PVI = pulmonary vein isolation; RA = right atrial; SVC = superior vena cava.

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  Figure 3. Ablation Procedure in Case 2 (A) Cranial view with voltage map of the pulmonary venous baffle. (B) Activation map of the tachycardia. Arrows (white) indicate the direction of the wavefront. (C) Right anterior oblique view showing CTI ablation (red dots) spanning both atria. (D) Pulmonary vein isolation around the right and left pulmonary veins with PFA (green dots) and RFA (red dots). (E) Rhythm strip from implantable cardiac monitor showing initial tachycardia. CTI = cavotricuspid isthmus; PFA = pulsed-field ablation; RFA = radiofrequency ablation; RSPV = right superior pulmonary vein.

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  Figure 4. Findings on Chest X-Ray and Ablation Procedure in Case 3 (A) Anteroposterior chest x-ray showing cardiac resynchronization device and valve prosthesis in the right ventricular outflow tract. (B) Fluoroscopy image (right anterior oblique view) showing the position of the Sphere-9 catheter (arrow) against the high right ventricular septum. (C) Septal and lateral views showing scar areas. (D) Radiofrequency ablation lesions connecting the tricuspid annulus to the scar on the septal and lateral aspects.

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  Figure 5. Findings on CT Angiography and Ablation Procedure in Case 4 (A) CT angiography anterior view showing right-sided aortic arch and RVOT conduit in a patient with double-outlet right ventricle and tetralogy physiology. (B) Right anterior oblique view showing the Sphere-9 catheter in the right ventricle. (C to F) RVOT scar (lateral and septal views) and RFA (red dots) and PFA (green dots) lesions encircling the scar boundary and connecting it to the tricuspid annulus. CT = computed tomography; PFA = pulsed-field ablation; RFA = radiofrequency ablation; RVOT = right ventricular outflow tract.

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  Figure 6. Findings on ECG and Ablation Procedure in Case 5 (A) ECG showing clinical ventricular tachycardia with inferior axis. (B) Septal and lateral views showing scarred areas and isthmus (small arrow). (C) Septal and lateral views showing RFA at both septal and lateral sites connecting the scar area to the right ventricular outflow tract. (D) Image showing combined atrial (cavotricuspid isthmus line) and ventricular RFA lesion. ECG = electrocardiogram; RFA = radiofrequency ablation.