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Three-dimensional nonfluoroscopic mapping and ablation of inappropriate sinus tachycardia

Procedural strategies and long-term outcome

Nassir F. Marrouche, MD^*, Salwa Beheiry, RN, Gery Tomassoni, MD, Christopher Cole, MD^*, Dianna Bash, RN^*, Thomas Dresing, MD^*, Walid Saliba, MD^*, Ahmad Abdul-Karim, MD^*, Patrick Tchou, MD^*, Robert Schweikert, MD^*, Fabio Leonelli, MD and Andrea Natale, MD^*,*

^* Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio,USA
Central Baptist Hospital, Lexington, Kentucky, USA

View larger version (72K): [in a new window]   Figure 1 Three-dimensional electroanatomic activation map (CARTO) of the right atrium showing the ability to tag anatomical structure relevant to the ablation procedure. (A) Right anterior oblique view of the right atrium during inappropriate sinus tachycardia. The gray tags represent sites where pacing was able to stimulate the phrenic nerve. Green tags reproduce the course of the crista terminalis. (B) The same activation map as in A, but in a more posteriorly rotated view. (C) The caudal shift of the earliest activation site following sinus node modification.

View larger version (91K): [in a new window]   Figure 2 Three-dimensional electroanatomic activation map (CARTO) of the right atrium. Spontaneous sinus tachycardia is shown after administration of esmolol (B) and following successful sinus node modification (C). Red represents early and purple represents late electrical atrial activation. (A) The earliest site of activation during inappropriate sinus tachycardia (IST) to be in the vicinity of the atrium-SVC junction. (B) A 3.5-cm caudal shift of the earliest activation site after administration of intravenous esmolol. A CARTO map after sinus node modification shows a 2.5-cm caudal shift in the earliest activation site along the crista terminalis. CS = coronary sinus; HIS = His-Bundle potential; SVC = superior vena cava; IVC = inferior vena cava; TV = tricuspid annulus.