What are we ablating above the semilunar valves? Insights from electrical navigation.

摘要

The incredible progress made over the last few decades with ablation for cardiac arrhythmia has, in large part, resulted from 2 factors:1'2 our understanding of the substrate that is being targeted for ablation and the use of anatomic flu-oroscopic views to guide the navigation of catheters targeting that substrate.Ablation of certain arrhythmias, however, is rendered complex and typically associated with poor outcomes when the substrate is not clearly known, when fluoroscopy is difficult to interpret, or both.The utility of the right and left anterior oblique views as generally anatomically easily interpreted projections is well recognized. However, certain anatomic structures are not well represented in these or any other fluoroscopic view. For example, the pulmonary vein ostia are very difficult to recognize accurately.3 In these instances, the value of recognizing characteristic electrograms that arise when mapping within the pulmonary vein versus the left atrium serves as an important, and at times, critical adjunct to fluoroscopy and other imaging modalities.