Silent steam pop detected by intracardiac echocardiography

Abstract

A 74-year-old man with old inferior wall myocardial infarction and left ventricular ejection fraction of 20% was admitted for recurrent ventricular tachycardia (VT) despite amiodarone therapy and 2 prior radiofrequency catheter ablation (RFCA) procedures. After informed written consent was obtained, the patient was transported to the electrophysiology laboratory. Two distinct morphologies of VT that were not hemodynamically tolerated were induced. A substrate-guided ablation was performed. Catheter mapping and ablation were performed with saline irrigated tip catheter using CARTO mapping (Biosense Webster, Diamond Bar, CA) as previously described. 1 Tokuda M. Kojodjojo P. Epstein L.M. et al. Outcomes of cardiac perforation complicating catheter ablation of ventricular arrhythmias. Circ Arrhythm Electrophysiol. 2011; 4: 660-666 Crossref PubMed Scopus (83) Google Scholar An intracardiac echocardiography (ICE) probe with a CARTO navigation sensor imbedded close to the phased array (Sound-Star, Biosense Webster) was positioned in the right ventricle (RV) and allowed the sequential acquisition of electrocardiogram-gated 2-dimensional images of the left ventricle (LV). The ICE images were synchronized to the ventricular potential, and the endocardial surface of the LV was traced on each image. These contours enabled the creation of a registered 3-dimensional shell of the LV. The catheter tip position can be verified as a green circle on the ICE image (Figure 1A) in real time by using feedback from the navigation sensor. A voltage map of the LV is shown with the upper limit for the bipolar electrograms of ≥2.0 mV represented by the purple color and progressively lower amplitude signals are indicated by blue, green, yellow, and red (Figure 1B). radiofrequency (RF) ablation targeted presumptive exit and channel regions.