Use of optimal fluoroscopic angulation to facilitate effective pulsed field ablation in a patient with atrial fibrillation

Figures

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  FIGURE 1. Simulated fluoroscopic angulations of the en face and perpendicular views of each PV ostium. The ostium of each PV (blue and yellow lines) is shown in the en face view (A) and perpendicular view (B), simulated by cardiac computed tomography. CAU, caudal; CRA, cranial; LAO, left anterior oblique; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; PV, pulmonary vein; RAO, right anterior oblique; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein.

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  FIGURE 2. Catheter manipulation using the optimal fluoroscopic image angulations. (A) The en face view of each PV enables the intuitive and straightforward adjustment of the No. 5 electrode positions (white arrows) at 12, 3, 6, and 9 o'clock to ensure optimal contact of the catheter on the wall in each direction. (B) The perpendicular view (left panels) enables the adjustment of the catheter's position on the ostial or antral sides of the PV. When the circular‐shaped catheter is pulled back toward the antral side, enlargement of the circle (widening of the distance between the No. 1 and No. 9 electrodes) is readily confirmed by the en face view (right panels). CAU, caudal; CRA, cranial; LAO, left anterior oblique; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; PV, pulmonary vein; RAO, right anterior oblique; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein.

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  FIGURE 3. Comparison between the adjusted and conventional angulations. Compared with the conventional angulations, which generally show foreshortened images of the circular pulsed field ablation catheter, the en face and perpendicular views can provide more circular and tangential images of the catheter, respectively. This helps in the fine adjustment of the catheter's position to ensure target region selection with optimal contact. CAU, caudal; CRA, cranial; LAO, left anterior oblique; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RAO, right anterior oblique; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein.