Visualization of an Accessory Pathway by 3D High-Density Mapping: A Case of Ebstein Anomaly With Atrioventricular Re-entrant Tachycardia

Figures

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  Figure 1. An anatomic map by CARTOSOUND (Biosense Webster, Inc, Diamond Bar, CA). The edge of the tricuspid valve leaflet is clearly observed (pink tags in left figure, pink arrows in right figure). An activation map is merged with the anatomical map. The gap between the identified true tricuspid valve annulus (white solid line) and the functional tricuspid valve annulus (white broken line) represents the ARV. ARV, atrialized right ventricle; FRV, functional right ventricle; RA, right atrium.

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  Figure 2. (A) A high-density activation map image taken during the atrioventricular re-entrant tachycardia. An obvious gap is observed between the true tricuspid valve annulus (white lines) and the functional tricuspid valve annulus (white broken line, pink tags). The accessory pathway is visualized as a segment of continuous ventriculoatrial (VA) conduction (yellow arrow) on the true tricuspid valve annulus. (B) X-ray fluoroscopy imaging of the catheter’s position was merged with a 3D mapping system. The success site was posterior to the true tricuspid valve annulus (green tag). (C) The ablation catheter at the accessory pathway shows continuous VA potentials (black arrow). (D) The local electrogram at the accessory pathway was recorded using a PentaRay catheter (Biosense Webster, Inc, Diamond Bar, CA). ABL, ablation catheter; ACP, accessary pathway; ARV, atrialized right ventricle; CS, coronary sinus; RA, right atrium; RV, right ventricle; RVA, right ventricular apex; TA, tricuspid annulus, TV, tricuspid valve.