Lt04z0095a.doc

Advanced Catheter Concepts - The Specialty CS
Diagnostic Catheter

With advancement in the field of cardiac the femoral vein to map right atrial sites. This electrophysiology and specifically in the field of ablation, the need for new tools to ease and facilitate the mapping and ablation procedures is Bard Electrophysiology has recently developed a new diagnostic catheter to further improve mapping during not only simple but also more complex supraventricular arrhythmias. The Specialty Coronary Sinus (SCS) catheter is a 6F, woven catheter available with either 20 or 14 poles. The electrode positioning features 2 distinct sets of electrodes separated by a spacing gap. (For example, the Bard model number 6FMC00789 has a distal group of 10 electrodes with 5-5-5mm spacing followed by a 42mm gap, then a proximal group of 10 electrodes with 5-5- instrumentation of the cardiac space, it also lowers the risk of cardiac injury and perforation associated with multiple instrumentation of the The SCS is finished with a proprietary distal curve, which is designed to facilitate cannulation of the Coronary Sinus (CS) using the right Moreover, extra punctures may be associated with added risk of complications such as AV- fistulae and bleeding. Using the SCS, an extra Figure 1 shows the 20 pole variant of the catheter femoral puncture would be saved leading to less with the distal 10 poles placed in the coronary sinus (CS) and the proximal 10 poles placed in procedures saves the operator significant procedure time, which would be a result of the Saving extra hardware in the cardiac chambers
time to place an extra sheath in the femoral vein and an extra puncture site
and the time to position the extra catheter in the During a supraventricular arrhythmia, mapping and ablation procedure catheters are used to record activation potentials from the mid-, high right atrium, from the His -bundle, and the Case Study
coronary sinus. Mapping of supraventricular A 54 year old female is presented for mapping arrhythmias using the SCS reduces the number and ablation of her paroxysmal atrial fibrillation of mapping catheters required per procedure, (AF). Patient has been suffering from AF for the reducing procedure time and increasing patient increased to 4-5 per week lasting between 1 and 8 hours. She would experience palpitations The SCS records potentials/activation from the associated with fatigue and shortness of breath CS and the mid and high right atrium in addition with the onset of AF. Failed flecainide, to the Right Atrium – Superior Vena Cava (RA- SVC) junction, saving additional cannulation of amiodarone. Patient presented for AF mapping and ablation. CS and positioning the SCS far distal into the recordings from the RA -SVC junction, HRA and echocardiogram guided pulmonary vein isolation procedure, we utilized the SCS catheter to define the origin of the premature beats initiating AF. In Isolating the Pulmonary Veins (PVs) and addition to an 10.5F ICE catheter inserted from the left femoral vein, a standard RF ablation After successful isolation of all PVs, extra beats catheter and a 7F circular mapping catheter initiating AF could still be documented. The (Bard Orbiter® PV) were also inserted via the activation sequence of the SCS revealed earliest right femoral vein into the left atrium by activation to be between electrode 8 and 9. We then repositioned the circular mapping catheter at the posterior antral portion of the right inferior PV and proved a focus to be firing from that s ite, The SCS was inserted via an 8F sheath into the which was then successfully targeted. Then, right jugular vein. After positioning the during testing and by using burst pacing and flouroscopy at 45° Left Anterior Oblique (LAO), the SCS was advanced into the right atrium unmasked. The earliest activation recorded per (RA). Immediately after approaching the HRA, SCS was demonstrated at poles 16 and 17 which were positioned at the RA-SVC junction. We counterclockwise manner towards the posterior then placed the circular mapping catheter at the and medial site of the right atrium where the CS junction and completed isolation of the SVC. We os usually located. The goal of the operator was then could not demonstrate Atrial Premature to continue rotating the SCS until its distal Contractions (APCs ) despite burst pacing and electrodes were lined up (perpendicular to the viewer) in the 45°LAO. This implied that the catheter was pointing towards the Coronary Sinus Ostium (CS os). We then slowly started Disclosure
The author wishes to disclose that Bard Electrophysiology
advancing the SCS with simultaneous minimal provided funding for the services in the final work product
counterclockwise rotation to allow engagement submitted for this publication.

of the catheter into the CS. This was verified by Bard and the Orbiter are registered trademarks of C.R. Bard,
recording potentials from electrodes 1 and 2, Inc. or an affiliate. All trademarks or registered trademarks are
the property of their respective owners. 2006 C.R. Bard Inc. All
which revealed the specific CS recording, an rights reserved. LT04Z0095/Rev01/01.2006
atrial and a ventricular signal. Asking the patient to take a deep breath simultaneously with slight advancement of the SCS helped cannulate the

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