Fluoroscopy Reduction Techniques for Catheter Ablation of Cardiac Arrhythmias - Razminia, Zei 9781942909309

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Fluoroscopy Reduction Techniques for Catheter Ablation of Cardiac Arrhythmias - Razminia, Zei 9781942909309

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Fluoroscopy Reduction Techniques for Catheter Ablation of Cardiac Arrhythmias

Edited By Mansour Razminia, MD, and Paul C. Zei, MD, PhD

Product Details:
Publication Date: May 2019
ISBN: 9781942909309
eISBN: 9781942909354
Trim Size: 8.5 x 11
Full color interior
Format: Paperback; eBook only

**To receive your free digital edition, if you purchased your book directly from Cardiotext, we will ship an access code with your print book. If purchased elsewhere, please send a copy of your receipt to info@cardiotext.com with subject line FLUOROLESS EBOOK, and we will email you a redemption code along with instructions on how to access the digital file. Please allow one business day for processing. 

About
Table of contents
Videos included with book purchase


About:

Background:

Catheter ablation has become a widely used approach to treating various cardiac arrhythmias. Traditionally, catheter ablation procedures are guided by fluoroscopic imaging to help understand catheter position during mapping. The potentially significant exposure to radiation to the patient, physician, and staff increases risks of radiation exposure-related disease. Also, the protective lead garments worn increases risks of orthopedic injury. Current advanced electroanatomic mapping and intracardiac echocardiography technology have allowed the development of endocardial catheter ablation techniques without the use of fluoroscopy safely and effectively.  

A host of expert and experienced authors present a practical overview of the rationale and methodology for a low- or zero-fluoro environment in the electrophysiology lab with the critical goal of significantly reducing radiation exposure to the patient, physician, and staff.

This practical guide:

  • Covers the entire spectrum of commonly (and less commonly) performed ablation procedures via endocardial approach.

  • Discusses general principles that are applicable across ICE and EAM platforms.

  • Will assist the electrophysiologist and their team to safely and effectively work toward the significant reduction in fluoroscopy utilization while also likely improving procedural safety, i.e., fewer complications, after the adoption of these techniques.

  • Includes a library of 50 videos, with 9 extended films (108 minutes) by Dr. Razminia detailing step-by-step procedures and techniques.

“An important text for all electrophysiologists, replete with crucial advice on the optimal use of nonfluoroscopic tools for better ablation safety and efficacy.”
-  Amin Al-Ahmad, MD

“I congratulate Drs. Razminia and Zei on a wonderful contribution to the electrophysiology literature that will foster continued advances in the field that will improve safety and outcomes. This book is a wonderful source of guidance toward that goal.”
-  William G. Stevenson, MD


Table of Contents

Section 1: Basis of Imaging in the Electrophysiology Lab

1 Radiation Safety in the Electrophysiology Lab

           Kristen Breedlove, John Clark

2 How to Use Intracardiac Echocardiography to Reduce Fluoroscopy

            Cameron Willoughby

3 How to Use Electroanatomic Mapping to Reduce Fluoroscopy

            Kristen Breedlove, John Clark

4 How to Use Technologies such as MediGuide and CARTOUNIVU to Reduce Fluoroscopy During Catheter Ablation

            Martin Borlich, Philipp Sommer

5 How to Obtain Central Vascular Access Using Real-time Ultrasound

            Carola Gianni, Carlos Monreal, Zachary J. Rosenblatt, Jason T. Engel, Clayton Robison, Rodney P. Horton, Andrea Natale, Amin Al-Ahmad

6 How to Perform Transseptal Puncture Without Fluoroscopy

            José Mauricio Sánchez

7 How to Maintain Safety With a Reduced Fluoroscopy Approach

            José Osorio, Gustavo X. Morales

8 How to Monitor Esophageal Temperature Without Fluoroscopy

            Oliver D’Silva, Hany Demo, Theodore Wang, Mansour Razminia

Section 2: Ablation of Supraventricular Tachycardia

9 How to Ablate Atrioventricular Nodal Reentrant Tachycardia Using No Fluoroscopy

            Nicholas Von Bergen, Ian H. Law

10 How to Ablate Accessory Pathways Using No Fluoroscopy

            Raman L. Mitra

11 How to Ablate Typical Atrial Flutter Using No Fluoroscopy

            Saurabh Shah

12 How to Ablate Atrial Tachycardia and Atypical Flutter Using No Fluoroscopy

            Dan Alyesh, Sri Sundaram

Section 3: Ablation of Atrial Fibrillation

13 How to Perform Radiofrequency Ablation of  Atrial Fibrillation Using No Fluoroscopy

            Robin Singh, Paul C. Zei

14 How to Perform Cryo-Balloon Ablation of Atrial Fibrillation Using No Fluoroscopy

            Hany Demo, Oliver D’Silva, Mansour Razminia

Section 4: Ablation of Ventricular Arrhythmias

15 How to Perform Premature Ventricular Complex Ablation Originating From the Right Ventricle and Right Ventricular Outflow Tract Using No             Fluoroscopy

            Christopher I. Jones, Roderick Tung

16 How to Perform Ablation in the Coronary Cusps Using No Fluoroscopy

            José Mauricio Sánchez

17 How to Perform Ablation of Premature Ventricular Complexes Originating from the Left Ventricular Outflow Tract Using No Fluoroscopy

            Nicholas J. Costa, Jim W. Cheung

18 How to Perform Papillary Muscle Premature Ventricular Complex Ablation Using No Fluoroscopy

            Oliver D'Silva, Hany Demo, Theodore Wang, Mansour Razminia

19 How to Perform Ablation of Ischemic and Non-Ischemic Ventricular Tachycardia Using No Fluoroscopy

            Amit Thosani

Section 5: Special Populations

20 How to perform Catheter Ablation During Pregnancy: Special Considerations

            John D. Ferguson

21 How to Perform Catheter Ablation in the Pediatric Population Using No Fluoroscopy

            Nicholas Von Bergen, Ian H. Law


Videos included with book purchase:

Chapter 2 How to Use Intracardiac Echocardiography to Reduce Fluoroscopy

Video 2.1 Home view. ICE catheter in the neutral position. RA is on the upper half of the screen. Tricuspid valve and RV on the lower half. The long-axis AV at 2 o’clock and RVOT at 4–5 o’clock. [00:06]

Video 2.2 Right ventricle view. The ICE catheter in the home view anterior tilt is applied with slight CW and CCW rotation continuously maintain the opening and closing of the tricuspid valve leaflets in view. The catheter is advanced, once across, returned to neutral. The catheter is rotated CW to scan though the RV, interventricular septum, LV and LA. [00:30]

Video 2.3 Septal view. CW rotation of ICE from home view until the IAS comes into view. [00:06]

Video 2.4 Left atrium from septal view. MV seen first at 6 o’clock. With CW rotation, the PV come into view as follows: left superior PV at 4 o’clock, followed by left inferior PV at 5 o’clock, followed by right inferior PV at 6 o’clock, and finally right superior PV at 5 o’clock. The esophagus is seen along the posterior wall between the left and right PV. Note left tilt was not needed to visualize the right PV in this case. [00:15]

Video 2.5 Left atrium from right ventricle view. CW rotation from the right ventricle view to scan through the left atrium. Left PV at 5 o’clock. AV at 11–12 o’clock. Right coronary cusp is at the top, non-coronary cusp along the IAS, and left coronary cusp near the MV. Note the left main coronary artery in the left coronary cusp. [00:15]

Video 2.6 Left ventricle from right ventricle view. Note the image has been flipped left to right. CW rotation from the right ventricle view, the posteromedial papillary muscle comes into view first with an ablation catheter adjacent to it. With further CW rotation the anterolateral papillary muscle then LV outflow tract comes into view. [00:10]

Video 2S Chapter summary and step-by-step procedures by Mansour Razminia [19:00]

Chapter 4 How to Use Technologies such as MediGuide and CARTOUNIVU to Reduce Fluoroscopy During Catheter Ablation

 Video 4.1 Ablation of atypical atrial flutter using Precision as the 3D mapping system and MediGuide for non-fluoroscopic catheter visualization. Mapping with a circular mapping catheter reveals counterclockwise perimitral flutter in LAT and sparkle map (TCL 211 ms). Ablation of anterior isthmus line prolongs TCL to 237 ms. New map shows localized septal reentry with a PPI = TCL at the septal annulus. Ablation here terminates the tachycardia. LAT map during SR proves the complete block of the septal line with a delay over the line of >150 ms. Final fluoroscopy time of the procedure is 0.3 min; radiation dose is 191 μmicroGy*m2. [03:11]

Chapter 6 How to Perform Transseptal Puncture Without Fluoroscopy

Video 6.1 The transseptal needle is advance into the long sheath. [00:03]

Video 6.2 The long sheath is then slowly brought down from the SVC under ICE visualization until the sheath and needle are located at the intra-atrial septum. [00:03]

Video 6.3 ICE imaging of transseptal puncture across intraatrial septum. [00:03]

Video 6.4 The sheath is advanced over the wire into the LA visualized under ICE guidance. [00:03]

Video 6S Chapter summary and step-by-step procedures by Mansour Razminia [10:49]

Chapter 8 How to Monitor Esophageal Temperature Without Fluoroscopy

Video 8S Chapter summary and step-by-step procedures by Mansour Razminia [7:17]

Chapter 9 How to Ablate Atrioventricular Nodal Reentrant Tachycardia Using No Fluoroscopy

Video 9.1 A step by step video tutorial for AVNRT ablation utilizing voltage and propagation wave collision mapping. [07:43]

Chapter 10 How to Ablate Accessory Pathways Using no Fluoroscopy

Video 10.1 Placement of a duodecapolar catheter in the coronary sinus [00:29]

Video 10.2 Yellow dots show His cloud and the His catheter is orange at the RA (red) right ventricle (green) junction. The decapolar catheter (blue) is shown in the CS (yellow). What appears to be a second CS catheter was a saved image of the original CS placement to make sure that the CS has not moved during the case. The real time CS catheter shows an inferior deflection at electrodes 7-8 due to pacing electrode selection, which is seen with EnSite. A 4-mm cryocatheter (Medtronic, Minneapolis Inc., MN) was used for ablation due to the proximity to the compact AV node. The red dot was used to mark the most proximal region of His bundle recording. The blue dots represent the ablation points. Note the use of transparency and color to delineate structures, catheters and key electrogram sites. The pathway was ablated without affecting AV nodal conduction despite a very small intermittent His bundle deflection on the second beat seen on the ablation catheter electrogram. Note the larger A to V ratio on the ablation catheter compared to the His bundle catheter. [00:40]

Video 10.3A ICE image and sound map of the left atrium. [00:02]

Video 10.3B Using SmartTouch catheter in the IVC to create volumetric map of the IVC, RA, SVC, and CS. The red dots represent the mitral annulus recorded on ICE. The pulmonary veins (blue and green are shown coming off the LA. The ablation catheter starts at the IVC and is advanced under force guidance and curved and swept in the RA to create the volumetric map. The esophagus can be seen behind the LA in brown. [01:17]

Video 10.3C Transseptal site on ICE, marked in blue on RA septum with integrated ICE and EAM. [00:37]

Video 10.3D Placing of CS catheter. [01:19]

Video 10.3E RAO and clipping plane and LAO with contact force SmartTouch catheter entering CS os with 4 g of force. Illustrates how the contact force is used to safely navigate the catheter to the distal CS and create the CS volumetric map. [00:14]

Video 10.3F Nonfluoroscopic technique for retrograde aortic access. LV (meshed grey) and ascending aorta (meshed pink), which is then merged with catheter map of the descending aorta and arch as the catheter is advanced. The catheter is then prolapsed into the left ventricle. [02:02]

Chapter 11 How to Ablate Typical Atrial Flutter Using No Fluoroscopy

Video 11S Chapter summary and step-by-step procedures by Mansour Razminia [5:35]

Chapter 12 How to Ablate Atrial Tachycardia and Atypical Flutter Using No Fluoroscopy

Video 12S Chapter summary and step-by-step procedures by Mansour Razminia [3:55]

Chapter 13 How to Perform Radiofrequency Ablation of Atrial Fibrillation Using No Fluoroscopy

Video 13.1 ICE images of the left atrium showing a,PentaRay and ablation catheter in the chamber, demonstrating the ability to visualize catheters in the left atrium in real time during mapping and ablation. [00:05]

Video 13.2 ICE images of the left atrium showing a PentaRay exiting the transseptal sheath into the left atrium, demonstrating the ability to track catheter movement and relationship to the left atrium continuously in real time. [00:42]

Chapter 14 How to Perform Cryo-Balloon Ablation of Atrial Fibrillation Using No Fluoroscopy

Video 14S Chapter summary and step-by-step procedures by Mansour Razminia [33:42]

Chapter 15 How to Perform PVC Ablation Originating From the RV and RVOT Using No Fluoroscopy

Video 15S Chapter summary and step-by-step procedures by Mansour Razminia [6:28]

Chapter 16 How to Perform Ablation in the Coronary Cusps Using No Fluoroscopy

Video 16.1 Phased array ICE used view and aid in ablation catheter navigating up the femoral artery and into the iliac and aorta retrograde through the arterial system. [00:03]

Video 16.2 ICE advanced within the venous system to visualize the ablation catheter. [00:03]

Video 16.3 ICE advanced within the venous system to visualize the ablation catheter. [00:03]

Video 16.4 The ICE catheter is placed into the SVC and directed toward the ascending aorta and follow the ablation catheter back down toward the cusps. [00:03]

Video 16.5 Rotation of the phased array ICE catheter counter clock wise or rightward will bring the NCC and RCC into view. [00:02]

Video 16.6 The left coronary cusp will be located to the left of the RCC. Clockwise rotation of the ICE catheter will bring the LCC into view. [00:03]

Video 16.7 Color doppler on ICE can be used to determine the location of ostium of the major coronary arteries in order to avoid injury to these structures. [00:03]

Video 16S Chapter summary and step-by-step procedures by Mansour Razminia [5:29]

Chapter 18 How to Perform Papillary Muscle PVC Ablation Using No Fluoroscopy

Video 18S Chapter summary and step-by-step procedures by Mansour Razminia [16:02]