B-PO03-212 USE OF A SENTINELTM CEREBRAL PROTECTION SYSTEM TO FACILITATE PULMONARY VEIN ISOLATION IN A PATIENT WITH LEFT ATRIAL MASS ARISING FROM THE SEPTUM SECONDUM

Abstract

We report the use of a cerebral embolic protection device (CPD) to aid pulmonary vein isolation (PVI) in a patient with a left atrial (LA) mass on the interatrial septum. N/A N/A A 64-year-old female with symptomatic paroxysmal atrial fibrillation (AF) despite antiarrhythmics underwent catheter ablation (CA). However, intracardiac echo (ICE) showed a small (0.6 x 0.6 cm) mass of varying echogenecity on LA side (mid to inferior aspect) of the interatrial septum (Fig 1A) so procedure was aborted. Cardiac MRI could not adequately define the mass. Dofetilide was initiated but patient continued to have symptomatic AF with high burden. Given concern for mass disruption and embolization, surgical ablation vs CA using CPD was discussed, and patient chose the latter. A SentinelTM CPD was placed through right radial artery with filters placed in right brachiocephalic and left common carotid arteries (Fig 1B). Under ICE guidance, single transseptal catheterization was performed with a RF needle, slightly superior and posterior to the mass (Fig 1C). A circular catheter was used to create LA geometry and PVI was successfully performed using a TacticathTM ablation catheter. Mass was still noted on ICE post-ablation. CPD was removed and debris collected by the filter showed mainly fat tissue (Fig 1D), suggesting the mass is likely a small LA myxoma. No acute neurological complications were noted. At 1-month follow-up, patient was in sinus rhythm with no neurological deficits. To our knowledge, this is the first reported use of SentinelTM CPD to guide AF CA due to an LA mass and demonstrates the minimally invasive options for curative therapy of symptomatic AF.