Catheter navigation by intracardiac echocardiography enables zero-fluoroscopy linear lesion formation and bidirectional cavotricuspid isthmus block in patients with typical atrial flutter

Figures

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  Fig. 1. a View of the right iliac vein and artery; b typical CTI view (white line); c diagnostic EP catheter placed on the CTI for entrainment manoeuvre; d visualisation of the coronary sinus ostium (RA = right atrium, LA = left atrium, CS = coronary sinus); e decapolar diagnostic catheter manoeuvered into the coronary sinus ostium; f diagnostic catheter (green arrow) placed in the coronary sinus (blue dashed line)

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  Fig. 2. a–d Typical ablation planes with CTI on the left side. The ablation catheter is dragged from the tricuspid valve ring to the inferior caval vein, maintaining the catheter on the echocardiographic plane to achieve the best possible line; e insufficient contact of the ablation catheter tip (blue arrow) to the target tissue due to a prominent Eustachian ridge; f corrected tissue contact by inversion of the ablation catheter (blue arrow)

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  Fig. 3. Red segment = depth of the CTI pouch; white segment = CTI length; blue segment = prominence of the Eustachian ridge

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  Fig. 4. Duration of different EPS steps in detail

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  Fig. 5. a RF ablation at the tricuspid valve (TV)–CTI junction; b, c ablation catheter dragged back to mid CTI, development of intramural hematoma at TV-CTI junction is noticed; d maximum size of intramural hematoma; e, f stable size of intramural hematoma throughout the rest of the procedure