Cavotricuspid isthmus ablation using multimodality imaging in Ebstein anomaly with a mechanical tricuspid valve replacement

Figures

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  Figure 1. Multislice contrast-enhanced computed tomography scan. A: The coronary sinus drains into the right atrium under the ring of the mechanical valve (white arrow). B: The right oblique view of the computed tomography scan revealed that the ring of the mechanical valve is located on the true atrioventricular annulus. CS = coronary sinus; RA = right atrium; RV = right ventricle.

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  Figure 2. A 3-dimensional geometry was created using a PentaRay catheter. An activation map of 503 points was acquired. The activation map of atrial flutter showing the clockwise activation pattern around the tricuspid annulus in the right anterior oblique (LAO) and left anterior oblique (RAO) views. IVC = inferior vena cava; SVC = superior vena cava.

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  Figure 3. A: The fluoroscopic aspect in the right oblique view during radiofrequency catheter ablation. B: Intracardiac echocardiography showing good contact of the ablation catheter (white arrow) at the ventricular end of the cavotricuspid isthmus. ABL = ablation.