Rhythm Interventions Online

Dr Lucas Boersma explains preparing a device for left atrial deployment. The blue capture device removes air underwater to prevent introducing air into the sheath. The device is then advanced past the sheath’s seal twice for secure positioning, ensuring safety during the procedure. #EPeeps

Dr Christian-H. Heeger explains a single-sheath approach for deploying a Prostyle device, where he repositions the sheath after placing the device. He then completes the suture deployment with precision, cutting it off to secure the closure. Dr Heeger highlights the efficiency and simplicity of the process, showcasing the final result—a smooth and successful outcome with minimal procedural complexity. #EPeeps

Roderick Tung discusses a live AF procedure, highlighting voltage discrepancies between endocardial and epicardial signals and the complexities of annotating arrhythmias. Using ICE imaging, he demonstrates precise grid catheter placement for optimal mapping and ablation, likening the setup to a "McGriddle sandwich" for its firm contact and positioning. #EPeeps

Dr. Devi G Nair, MD, FACC, FHRS explains the process of tagging lesions on the mapping system using the PulseSelect catheter, focusing on the fifth electrode for optimal contact due to its 20-degree tilt. Lesions are placed at key positions—12:00, 3:00, 6:00, and 9:00 o’clock —starting with osteo lesions inside the pulmonary vein where signals are still present. The catheter is then repositioned to create wider antral lesions, forming a broad circumferential ablation around the vein. The animation demonstrates this by showing four initial lesions and detailing how six to eight antral lesions may be added depending on the anatomy.

In this video, K.R. Julian Chun and David Schaack analyse atrial wavefront propagation during an electrophysiology procedure. The blue arrow on the catheter visualises the wavefront direction, confirming a conduction block along the anterior line by showing the wavefront moving from the lateral inferior mitral valve towards the line. They note that without the line, the arrow would point in the opposite direction, indicating unblocked conduction. Challenges arise in assessing the roof line due to weak or absent signals, complicating confirmation of a conduction block. Would you try to induce? Comment below. #EPeep

In this video, Roderick Tung highlights key steps in managing signal clarity and catheter stability during an electrophysiology procedure. Roderick Tung notes that EnSite provides clearer diastolic component visibility due to its filtering, aiding integration of data for accurate ablation. Using 50 watts of power and 16 grams of force, he monitors the catheter’s position, counterclockwise rotating it. #EPeeps

Dr. Devi G Nair, MD, FACC, FHRS demonstrates a pulmonary vein isolation procedure, starting in the basket configuration to assess pulmonary vein sleeve length and determine lesion placement. The PFA system and visualisation software provide clear guidance on catheter positioning, enhancing procedural accuracy. Devi Nair performs four lesion applications in the basket configuration before transitioning to flower or olive setups if needed. Intracardiac echocardiography (ICE) ensures effective contact throughout, supporting safe and precise lesion delivery. #EPeeps

This video demonstrates the evaluation of device performance during a left atrial appendage closure (LAAC) procedure, focusing on post-implant patency and device flexibility. The presenter highlights post-implant observations from CT imaging at three months, where contrast patency is significantly reduced with this device compared to others. While some devices show residual patency in 30–50% of cases, this device exhibits contrast in only 15%, indicating its superior occlusion efficiency. #EPeeps

K.R. Julian Chun explains the functioning and feedback mechanism of Affera and Sphere 9, particularly focusing on how it measures and indicates tissue contact. He notes that while this catheter does not provide a direct contact force measurement in grams, it instead calculates or virtually estimates this information. Visual indicators, such as specific points and arcs around the catheter, are used to assess its position and contact status. These indicators are visible in fluoroscopic views like the RAO (right anterior oblique) and right lateral projections. White points on the display serve as markers, signalling when the catheter is in close proximity or in direct tissue contact.

Andrea Droghetti explains a surgical technique for creating a virtual pocket in the body, specifically highlighting its precision and minimally invasive nature. He begins by describing the approach using a lateral tear to expose the latissimus dorsi muscle, which can then be held aside with a retractor. The procedure involves the use of digitoclasy, a technique where the surgeon uses their fingers to create the pocket, avoiding the need for cutting or extensive dissection. #EPeeps