Dextrocardia and atrial fibrillation ablation: relevance of anatomy

Excerpt

A 75-year-old female with dextrocardia, situs solitus, and a structurally normal heart underwent (Fig. 1 a and b) successful pulmonary venous isolation ((PVI) via cryoablation for persistent atrial fibrillation (Fig. 1 g and h). Cardiac computerized tomographic (CT) imaging showed normal PV connections to the morphologic left atrium (Fig. 1c–f) and normal systemic venous connections to the morphologic right atrium. A 28-mm Arctic Front Advance™ (Medtronic, Minneapolis, MN, USA) cryoballoon catheter was advanced through FlexCath Advance™ steerable sheath (Medtronic, Minneapolis, MN, USA) to deliver freeze lesions. Contrast medium was injected through the central lumen of the cryoballoon to verify complete occlusion of the PV ostium. A 20-mm Achieve Advance™ mapping catheter (Medtronic, Minneapolis, MN, USA) was utilized to check for success of PVI after each freeze lesion. An additional bonus freeze was delivered to each PV after the successful freeze lesion. A total of 11 freeze lesions (duration: 50 to 180 s; temperature: − 28 to − 58 °C) were delivered to the 4 PVs. The total procedure time (excluding pre-procedural TEE) was 2 h and 57 min, and fluoroscopy time was 59 min. Difficulty in transseptal access and cannulating the coronary sinus contributed to the longer than usual fluoroscopy time in our patient.

…