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Fluoroscopic anatomy for supraventricular tachycardia ablation Hui-Nam Pak, MD, PhD Division of Cardiology, Yonsei Cariovascular Center and Cardiovascular Research Institute, Yonsei University

1 Fluoroscopic anatomy for supraventricular tachycardia ablation Hui-Nam Pak, MD, PhD Division of Cardiology, Yonsei Cariovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea Fluoroscopic anatomy for supraventricular tachycardia ablation ABSTRACT Radiofrequency catheter ablation has become a major treatment strategy for tachyarrhythmia. Although developments of catheter technology and 3D mapping systems have made remarkable progress in the ablation success rate, fluoroscopy is still one of the most important equipments guiding the catheter to the target lesion. Especially, in patients who require focal ablation, catheter navigation is mostly dependent on the fluoroscopic anatomy. Here, I would like to review the cardiac anatomy from the view point of fluoroscopic images, especially during the ablation of supraventricular tachyarrhythmias. Key words: fluoroscopy anatomy catheter ablation supraventricular tachycardia Received: March 14, 2011 Accepted: June 29, 2011 Correspondence: Hui-Nam Pak, MD, PhD, Division of Cardiology, Yonsei Cariovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Korea 250 Seungsanno, Seodaemun-gu, Seoul, Republic of Korea Tel: , Fax: hnpak@yuhs.ac VOL.12 NO.2 19

2 A B SAN SAN C D RSPV RIPV LSPV LIPV RIPV RSPV LSPV CS LAA MVA CS Figure 1. Fluoroscopic anatomy of right atrium (A and B) and left atrium (C and D). Sinoatrial node (SAN) exists on the junction between superior vena cava and right atrial appendage. Left atrium is connected with 4 pulmonary veins (PV) and left atrial appendage (LAA). Coronary sinus (CS) is located on the epicardial surface on posterolateral portion of left atrium. LIPV; left inferior PV, LSPV; left superior PV, RIPV; right inferior PV, RSPV; right superior PV 20 Journal of Cardiac Arrhythmia

3 A B VOM VOM C MCV D MCV ABL ABL Figure 2. The relationship between coronary sinus (CS: A and B) and posteroseptum (C and D). Middle cardiac vein (MCV) branches at immediately proximal to CS ostium and vein of Marshall (VOM) separates the boundary of CS and great cardiac vein. Slow pathway of AV node exists on the lower 1/3 between CS ostium and His bundle recording area. VOL.12 NO.2 21

4 A B C D Figure 3. The proper location of trans-septal puncture (A and B) and the relationship between esophagus and posterior left atrial wall (C and D). 22 Journal of Cardiac Arrhythmia

5 Koch s triangle References 1. Ho SY, Anderson RH, Sanchez-Quintana D. Atrial structure and fibres: morphologic bases of atrial conduction. Cardiovasc Res. 2002;54: Corcoran SJ, Lawrence C, McGuire MA. The valve of Vieussens: an important cause of difficulty in advancing catheters into the cardiac veins. J Cardiovasc Electrophysiol. 1999;10: Choi JI, Pak HN, Park JH, Choi EJ, Kim SK, Kwak JJ, Jang JK, Hwang VOL.12 NO.2 23

6 C, Kim YH. Clinical Significance of Complete Conduction Block of the Left Lateral Isthmus and Its Relationship with Anatomical Variation of the Vein of Marshall in Patients with Nonparoxysmal Atrial Fibrillation. J Cardiovasc Electrophysiol. 2009;20: Sun Y, Arruda M, Otomo K, Beckman K, Nakagawa H, Calame J, Po S, Spector P, Lustgarten D, Herring L, Lazzara R, Jackman W. Coronary sinus-ventricular accessory connections producing posteroseptal and left posterior accessory pathways: incidence and electrophysiological identification. Circulation. 2002;106: Hwang C, Peter CT, Chen PS. Radiofrequency ablation of accessory pathways guided by the location of the ligament of Marshall. J Cardiovasc Electrophysiol. 2003;14: Journal of Cardiac Arrhythmia

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ºÎÁ¤¸ÆÃÖÁ¾ MAIN TOPIC REVIEWS Young-Keun On, MD, PhD Division of Cardiology, Department of Medicine Cardiac & Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Catheter