eMedicine Specialties > Cardiology > Electrophysiology Procedures
Catheter Ablation: Multimedia
Updated: Oct 14, 2008
Multimedia
 | Media file 1: Diagrammatic schema of the typical type of atrioventricular nodal reentrant tachycardia (AVNRT). The slow pathway (dashed arrow) is the usual antegrade limb of the reentry circuit and the usual ablation target area (shaded). The fast pathway (solid arrow) is the usual retrograde limb of the reentry circuit and commonly activates the atria simultaneously with ventricular activation, producing the typical ECG finding of AVNRT shown below. The P wave is not visible because it is buried in the QRS complex. Infrequently, the reentry circuit is reversed, with antegrade conduction over the fast pathway and retrograde conduction over the slow pathway, producing the atypical ECG finding of AVNRT shown below (ie, long R-P tachycardia, in which the interval between the QRS complex and retrograde P wave is longer than the subsequent P-R interval, and the P wave is in the second half of the R-R interval). The fast pathway is close to the compact atrioventricular node, and ablation in this area is avoided if possible because of the risk of iatrogenic heart block. |
 | Media file 2: The pseudo S waves inferiorly (compare this to the sinus rhythm ECG in Image 3) are retrograde P waves. This short interval between the QRS complex and the retrograde P wave is highly specific for atrioventricular nodal reentrant tachycardia (AVNRT). A pseudo R wave in V1 may also be observed, but this is not shown here. In many instances, the retrograde P wave occurs during QRS activation and is not observed; this "no-P-wave" tachycardia (see Media file 1) also suggests AVNRT. |
 | Media file 3: Sinus rhythm in a patient with atrioventricular nodal reentrant tachycardia. |
 | Media file 4: Schema of orthodromic reciprocating tachycardia (ORT). The atrioventricular node serves as the antegrade limb, whereas an accessory pathway (atrioventricular connection) serves as the retrograde limb. For ECG features of ORT, see Media file 5. |
 | Media file 5: Supraventricular tachycardia (SVT) in a patient with orthodromic reciprocating tachycardia (ORT) due to a concealed pathway. Note the retrograde P wave, seen best in lead V2, separated from the QRS complex by an isoelectric baseline. (Compare to Media file 2, in which the P wave is fused to the QRS.) This pattern of "short R-P tachycardia" (in which the interval between the QRS complex and retrograde P wave is shorter than the subsequent P-R interval and the P wave is in the first half of the R-R interval) suggests an SVT incorporating an accessory pathway. |
 | Media file 6: Schema of the common variety of atrial flutter. The reentry circuit is confined to the right atrium and circulates as a counterclockwise macroreentrant circuit proceeding superiorly over the atrial septum and inferiorly over the lateral atrial wall. The wave front circulates through a narrow isthmus of tissue between the tricuspid valve annulus and the inferior vena cava. Linear ablation across this isthmus cures this common form of atrial flutter. For ECG features, see Media file 7. |
 | Media file 7: An example of a typical counterclockwise atrial flutter, the most common form of atrial flutter. The cardinal features are a perfectly regular atrial rhythm with inverted P waves inferiorly that have a positive overshoot, upright P waves in V1, and inverted P waves in V6. |
 | Media file 8: Electroanatomic map of the posterior left atrium, illustrating the pulmonary veins: right superior pulmonary vein (RSPV), right inferior pulmonary vein (RIPV), left superior pulmonary vein (LSPV), and left inferior pulmonary vein (LIPV). The red circles represent actual discrete radiofrequency applications, predominantly delivered in a circumferential pattern around the pulmonary veins. This ablation strategy can isolate pulmonary vein foci that initiate atrial fibrillation, and/or alter the substrate of the left atrium to inhibit fibrillatory activity due to reentry. Image courtesy of American College of Cardiology Foundation. |
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References
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Further Reading
Keywords
RFCA, radiofrequency ablation, catheter ablation, tachyarrhythmias, tachycardias, supraventricular tachycardia, SVT, orthodromic reciprocating tachycardia, ORT, unifocal atrial tachycardia, ventricular tachycardia, VT, Wolff-Parkinson-White syndrome, WPW syndrome, atrial flutter, atrial fibrillation, atrioventricular nodal reentrant tachycardia, AVNRT, polymorphic ventricular tachycardia, ventricular fibrillation, paroxysmal atrial fibrillation, idiopathic ventricular tachycardia
