Epicardial left ventricular mapping using subxiphoid video pericardioscopy.

We report a novel subxiphoid video pericardioscopy approach for epicardial mapping that allows direct visualization of the epicardium with minimal use of fluoroscopy. The FLEXview system (Boston Scientific Cardiac Surgery, Santa Clara, CA), which is capable of a free navigation around the heart owing to its flexible neck, was inserted into the pericardial space through a small subxiphoid incision. A commercially available mapping catheter advanced through the working port of the device could be navigated around virtually the entire biventricular epicardial surface.

Echocardiographically guided left atrial ablation: characterization of a new technique.

Background: Several techniques for percutaneous catheter-based radiofrequency ablation of left atrial myocardium have been described. Each is potentially limited by anatomic inaccuracy, radiation requirement, cardiac/extracardiac collateral damage, proarrhythmia, lesion impermanence, or unclear procedural endpoint.

Objectives: The purpose of this study was to describe a new technique that may address some of these limitations.

Common left pulmonary vein: a consistent source of arrhythmogenic atrial ectopy.

Introduction: The discovery of a consistent relationship between atrial anatomy and electrophysiology would have practical value and may provide insight into arrhythmia mechanism. We previously observed that anatomically common left pulmonary veins were a disproportionate source of atrial ectopy that was associated with the initiation of atrial fibrillation ("arrhythmogenic"). This report details our efforts to characterize and quantify this observation.

Catheter ablation to suppress atrial fibrillation: evolution of technique at a single center.

Background: Catheter ablation of atrial fibrillation is a rapidly evolving art. There is currently no consensus as to optimal methodology. We report a sequential experience, during which three distinct ablation techniques were utilized.