Abstract
A 74-year-old man with hypertrophic cardiomyopathy and paroxysmal atrial fibrillation, requiring multiple cardioversions for unstable rapid ventricular rates, was referred for electric isolation of his pulmonary veins. Wide-area circumferential ablations, combined with targeting of pulmonary vein potentials, were used to electrically isolate all 4 pulmonary veins. Before ablation, a transesophageal echocardiogram was performed after induction of general anesthesia. Ablation was performed with a closed, irrigated 4-mm tip (Chilli catheter, Boston Scientific, Natick, MA) with power levels of 30 W on the anterior left atrial wall and 20 W posteriorly. The temperature was limited to 40°C. An esophageal temperature probe was inserted for continuous monitoring but was difficult to advance to its proper location. Ablation was guided by a 3-dimensional representation of a contrast-enhanced cardiac computed tomography (CT) scan (Ensite Fusion, St Jude Medical, Minnetonka, MN). Intravenous heparin was administered to maintain the activated clotting time at 350 to 400 seconds. …
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