Abstract
A 51-year-old male a with 3-year history of symptomatic, drug-refractory paroxysmal atrial fibrillation was brought to the electrophysiology laboratory for pulmonary vein isolation (PVI). His medical history included osteoarthritis of the left shoulder and heel. A preprocedure contrast-enhanced 64-slice cardiac computed tomography (CT) was obtained for image integration with the electroanatomic mapping system (NavX, St. Jude Medi-cal Inc. St. Paul, Minnesota). During three-dimensional (3D) CT segmentation of the left atrium (LA), two discrete indentations in the posterior wall were noted (Figure 1 panel A, left posterior oblique view). Upon examination of the raw CT data, those indentations corresponded to thoracic spinal vertebral body osteophyte (O) formations, protruding into the posterior LA wall (panel B, sagittal view). Using the electroanatomic mapping system, the LA geometry was reconstructed and then integrated with the 3D CT image. The osteophytes protruding into the LA were also observed by intracardiac echocardiography (panel C). Catheter stability was cumbersome when ablating the posterior aspect of the right pulmonary veins antrum where the osteophytes protruded into the LA wall. To overcome this, the catheter was manipulated carefully slightly rightward to the tip of the protruding osteophytes. The right pulmonary veins were successfully isolated after the first set of circumferential ablation lesions. Electrical isolation of all PVs was confirmed at the end of the procedure by a circular mapping catheter. The final ablation lesions are shown in panel D.
Published Version
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