Allied Professionals (Non-physician submissions only) -> Teaching Case Reports D-AB18 - Quirks and Quarks from the EP Lab (ID 38) Abstract

D-AB18-06 - Unanticipated Diagnoses And Challenges During Catheter Ablation Of Atrial Fibrillation (AF) (ID 787)


 C.S. Yacono: Nothing relevant to disclose.

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Background: Conventionally, catheter ablation (CA) of AF is accomplished via trans-femoral venous access (TFVA), intra-cardiac echo (ICE) guided trans-septal puncture (TSP), the CA itself, and drug challenges using isoproterenol (IP) or adenosine coupled with pacing maneuvers. Given the global burden of AF and the ever-expanding role for CA, it should not be surprising to have unusual circumstances which can pose unique challenges.
Objective: We report a case series of 4 patients, each referred for CA of AF, and each with distinct findings which were not apparent until the time of the procedure.
Results: 1. A 58 year old had an absent IVC found during TFVA, confirmed by contrast injection and MRI. US-guided hepatic vein cannulation permitted atrial access, TSP, and completion of the CA with hemostasis via a gel foam plug. 2. A 63 year old with a negative stress test had PVCs originating from the basal posterior LV triggering VF during IP infusion. Angiography revealed a right PDA stenosis which was stented. 3. A 75 year old with chronic HFpEF had a dense apical cap on fluoroscopy and equalization of diastolic BPs consistent with constrictive pericarditis, later elucidated by CT. 4. A 76 year old had diffusely abnormal LA voltage, thickened LV on ICE, and LV scar on MRI, all compatible with amyloidosis.
Conclusion: Advanced imaging, refined mapping, and the increasing utility of CA in AF all appear instrumental in unveiling pathologies at the time of procedure which may have gone undetected by more routine screening tools. Moreover, the operator should be prepared for such challenges which not only pose threats to the safety and efficacy of CA, but may also have long term treatment implications.