Clinical usefulness of a multielectrode basket catheter for idiopathic ventricular tachycardia originating from right ventricular outflow tract

INTRODUCTION: It often is difficult to determine the optimal ablation site for idiopathic ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT) when the VT or premature ventricular complex (PVC) does not occur frequently. The aim of our study was to evaluate the usefulness of a multielectrode basket catheter for ablation of idiopathic VT originating from the RVOT. METHODS AND RESULTS: Radiofrequency (RF) catheter ablation was performed using a 4-mm tip, quadripolar catheter in 50 consecutive patients with 81 VTs originating from the RVOT with (basket group = 25 patients with 45 VTs) or without (control group = 25 patients with 36 VTs) predeployment of a multielectrode basket catheter composed of 64 electrodes. Deployment of the multielectrode basket catheter was possible and safe in all 25 patients in the basket group. Ablation was successful in 25 (100%) of 25 patients in the basket group and in 22 (88%) of 25 patients in the control group. The total number of RF applications and the number of RF applications per PVC morphology did not differ between the two groups. However, both the fluoroscopic and ablation procedure times per PVC morphology were shorter in the basket group than in the control group (36.8+/-14.1 min vs 52.0+/-32.5 min, P = 0.04; 60.0+/-14.6 vs 81.5+/-51.2 min, P = 0.05). This difference was more pronounced in the 29 patients in whom VT or PVC was not frequently observed. CONCLUSION: The multielectrode basket catheter is safe and useful for determining the optimal ablation site in patients with idiopathic VT originating from the RVOT, especially in those without frequent VT or PVC.     

Thermography basket catheter: in vivo measurement of the temperature of atherosclerotic plaques for detection of vulnerable plaques.

We have developed an intravascular thermography basket catheter to measure the temperature of the vessel wall to locate foci of inflammation. Our 3 Fr thermography basket catheter is a thermocouple-based catheter made of a nitinol expandable and externally controllable basket system loaded with nine small and flexible built-in thermosensors. It is equipped with real-time data acquisition software with a thermal resolution of 0.0001 degrees C and a sampling rate of 20 readings per second. In 10 inbred cholesterol-fed dogs with femoral (but not carotid) atherosclerosis, we found foci of warmth on the surface of atherosclerotic but not disease-free regions (P < 0.05). Marked temperature heterogeneity was also observed in the aortas of atherosclerotic Watanabe rabbits but not in normal rabbits. The catheters showed satisfactory accuracy, reproducibility, and safety. If confirmed in further studies, it has the potential to be utilized in detection of vulnerable plaques.     

Transluminal removal of an embolized venous catheter fragment with simple means: a case report

Vascular catheters are associated with complications like infection, thrombosis and stenosis. The embolization of a venous catheter fragment is a rare complication. This report presents a successful transluminal removal of an embolized catheter fragment in a 87-year-old patient who underwent on operative revision with renewed resection and postoperative multiorgan failure. The patient needed a large-bore catheter due to acute renal failure. By replacing the central venous catheter using the Seldinger technique a catheter fragment embolized in the right ventricle. This catheter fragment was removed with a Dormia basket.     

多电极网篮状导管标测技术的临床应用

多电极网篮状导管可作心内膜多位点同步标测。结合特定的分析处理软件 ,可对多种复杂心律失常进行标测并指导其消融过程。尤其对于持续时间短或血流动力学不稳定的心律失常有极大的应用价值     

Percutaneous retrieval of a broken silastic catheter from the left atrium in a critically ill premature infant

A critically ill premature neonate (birthweight 1,395 g, gestational age 30 wk) had a broken silastic catheter lodged in the left atrium. We successfully retrieved the foreign body by percutaneous approach using a helical basket catheter under echocardiographic control. Such a therapeutical option for a broken, lightly radiopaque catheter has not been previously described in very low birthweight, critically ill infants. Cathet. Cardiovasc. Diagn. 42:409–411, 1997. © 1997 Wiley-Liss, Inc.     

Insights into the mechanism of sustained ventricular tachycardia after myocardial infarction in a closed chest porcine model using a multielectrode "basket" catheter

INTRODUCTION: Accurate analysis of the arrhythmia substrate is important for successful radiofrequency ablation of sustained ventricular tachycardia (VT) after myocardial infarction (MI). METHODS AND RESULTS: A multielectrode "basket" catheter capable of endocardial recording and pacing was inserted percutaneously into the left ventricle of post-MI swine for analysis of the mechanism of sustained VT. Sustained VT was induced in 42 of 61 pigs that survived an acute MI produced by percutaneous transluminal coronary angioplasty balloon occlusion of the left anterior descending coronary artery and injection of agarose gel beads. A multielectrode "basket" catheter (Constellation) with 64 electrodes was inserted in 35 of these animals for analysis of the VT. Induced VT had a cycle length of 179 +/- 25 msec at control and 230 +/- 43 msec after administration of intravenous procainamide. Presystolic electrical activity was recorded from at least 1 of 32 bipolar pairs of electrodes at a mean 40.7 +/- 23.6 msec prior to QRS onset. Isolated mid-diastolic potentials were recorded in 26 of 35 animals. In 22 animals, there were multiple isolated potentials recorded from adjacent electrode pairs. Isochronal maps demonstrated that these potentials returned to the systolic site of origin. Resetting of sustained VT by single premature ventricular stimuli was observed in 6 of 12 animals. Entrainment with overdrive pacing was seen in 19 of 26 animals with induced VT. Concealed entrainment was observed in ten animals. The mean stimulus to QRS interval was 45 +/- 28 msec. Concealed entrainment was observed from adjacent electrode pairs with different stimulus to QRS intervals. CONCLUSION: These data suggest that sustained VT in this model is due to reentry with an excitable gap. A multielectrode "basket" catheter is useful for analyzing the zone of slow conduction participating in the tachycardia circuit. Such analysis may provide useful information to guide successful catheter ablation of sustained VT after MI.     

网篮电极导管临床使用的初步经验

目的：评价64极网篮电极导管在电生理检查及射频消融中的实用价值。方法：4例患者,根据发作时心电图诊断为房性心动过速（房速）3例,左心室室性心动过速1例,网篮电极导管分别经右侧股静脉或股动脉送入右心房或左心室,选择记录双极心电信号,对每1例患者均进行窦性心律及心动过速时的标测,并在网篮电极导管指引下进行消融,结果：4例患者网篮电极导管均顺利送入,术中及术后无明显并发症发生,通过网篮电极所记录心电信号清晰,稳定,根据计算机所绘制等时标测图及网篮在心腔内的影像位置,可准确地判断除极波传播顺序,方向及最早激动点,确定心律失常的起源部位及发生机制,2例房速及1例室性心动过速患者消融成功,另1例房速患者消融失败。结论：利用网篮电极导管进行心内膜高密度标测,有助于提高心脏电生理检查及射频消融手术的效率。     

经内镜逆行胰胆管造影术中不同取石器械对胆总管结石的疗效及安全性分析

目的 比较经内镜逆行胰胆管造影术（ERCP）中不同取石器械取石的效果及安全性。方法 回顾性分析2015年1月—2018年8月在南京市江宁医院及池州市人民医院行ERCP取石治疗的178例胆总管结石患者资料。患者先使用扩张气囊充分扩张乳头口，再行取石。根据取石器械不同，分为单纯气囊组（54例），单纯网篮组（60例）及网篮联合气囊组（64例），比较各组一次性结石清除率、术后24 h血淀粉酶水平及并发症发生率。结果 单纯气囊组、单纯网篮组及网篮联合气囊组一次性结石清除率分别为96.3%（52/54）、95.0%（57/60）、95.3%（61/64），3组比较差异无统计学意义（χ2=0.120,P=0.942）。3组术后24 h血淀粉酶水平分别为180.5（85.2,410.5）U/L、129.0（59.0,287.0）U/L、100.0（58.2,166.2）U/L，差异有统计学意义（H=9.655，P=0.008）。ERCP术后高淀粉酶血症、出血、术后胰腺炎发生率3组比较差异均无统计学意义（P均＞0.05）。3组均无穿孔发生，但网篮组发生结石嵌顿1例。结论 在使用扩张气囊充分扩张乳头口的情况下，ERCP取石可优先选用气囊取石，其具有较高的取石成功率，并发症发生率无显著升高，且不会发生取石器械嵌顿。     

Properties of unipolar electrograms recorded with a multielectrode basket catheter

In the past few years, clinical trials with multielectrode “basket” catheters have provided unique recordings from the endocardium of intact in-situ human hearts. Analysis of these recordings is difficult because unipolar electrograms obtained from a basket catheter in the blood-filled cavity differ from those obtained by other mapping techniques such as endocardial balloons used during antiarrhythmic surgery. We investigated these differences using basket catheter recordings obtained in isolated porcine and canine hearts that could be filled with perfusion fluid and evacuated at will. The results indicated that the differences between basket and balloon recordings are largely attributable to the presence and absence of blood. Activation maps obtained in the presence and absence of blood were usually similar and only differed in a minority of cases at sites in which electrograms revealed multiple deflections. In conclusion, unipolar mapping using a basket catheter can be used with confidence for the creation of activation maps if appropriate care is taken in the interpretation of fractionated electrograms.     

Transcutaneous removal of an intravenous catheter fragment using a spider FX™ Embolic Protection device

Long‐term use of intravenous catheters can lead to catheter fracture and embolization of fragments. Transcutaneous retrieval of these catheter fragments can be challenging because of their fragility. We report an 8‐year‐old boy with Hemophilia disease who underwent removal of intravenous Port catheter after 7 years of use, resulting in embolization of fractured catheter fragments into the distal pulmonary arteries. The snare technique to pull the snared fragment into a sheath was unsuccessful, and it leads to further breakdown due to its fragility. An alternative technique using a combination of a snare kit and a Spider FX? Embolic Protection Device was employed. This technique allowed the fragments to be secured proximally with the basket device and distally with the snare. The unit was then pulled through a sheath and removed from the body. To our knowledge, Spider FX? Device has not been used in this way before. © 2015 Wiley Periodicals, Inc.     

Indwelling pericardial drainage catheter break secondary to heart movement and catheter angulation

We report on a case of a pericardial drainage catheter that severed on attempted removal. Surgery was required to remove the retained portion. No manufacturing defects were found on analysis of the catheter. Shear forces due to heart movement and the angle of catheter entry into the pericardium were the suspected reasons for the catheter disruption. Cathet. Cardiovasc. Diagn. 42:58–60, 1997. © 1997 Wiley-Liss, Inc.     

Technique for shortening angioplasty guide catheter length when therapeutic catheter fails to reach target stenosis

Occasionally, the usable length of a balloon angioplasty or other therapeutic catheter is insufficient to reach the target stenosis. We describe a technique of shortening the guide catheter from the proximal end in vivo without removing the coronary guidewire. This permits greater projection of the therapeutic catheter to reach distal stenoses.© 1993 Wlley-Liss, Inc     

Balloon catheter systems for PTCA: The importance of the catheter length

The length of a balloon catheter system plays an important role in successfully dilating distal coronary or vein graft stenoses. We herein report a case in which a distal saphenous vein graft lesion could not be reached with a conventional balloon catheter. Factors responsible for this failure included insufficient length. The lesion was eventually reached and successfully dilated with another balloon catheter, which according to the manufacturer had the same length as the first balloon. In order to study this phenomenon eleven balloon catheters were examined using the following measurements: functional catheter length, deliverable catheter length, crossing distance and longitudinal compression. Seven guide catheters were also measured. Results showed variations in standard functional length between several manufacturers, ranging from 132.2–137.8 cm. The deliverable length ranged from 18.3–23.9 cm, crossing distance ranged from 7–37 mm, and the longitudinal compression ranged from 4–30 mm. Guiding catheter length varied among several manufacturers, ranging from 100.6–107 cm. A significant variation was found not only among certain manufacturers, but also among several standard catheters made by one manufacturer. The results of this study suggest that significant variations exist in the length of standard balloon catheters and guiding catheters even among those made by the same manufacturer. These findings can affect the ability to reach a lesion and should be taken into account, especially when attempting to perform angioplasty of stenoses located in the distal portion of a coronary artery or saphenous vein graft.     

The probe exchange catheter

In order to provide exchange capability to non-over-the -wire systems (i.e., Probe), an exchange catheter composed of an inner sheath catheter (.039″ external diameter) and a 4 French outer catheter was devised. The system was utillized to exchange between an over- to a non-over-the-wire system, different non-over-the-wire systems, and to provide balloon dilatation backup to the soft non-over-the-wire systems in difficult-to-engage vein graft takeoff. The system was sccessful utilized in 50 patients without any related complications.     

New guiding catheter for transrad PTCA

A new guiding catheter for PTCA is described. In our department, 302 patients (405 lesions) underwent transradial coronary angioplasty using the 6 Fr Kimny guiding catheter since January 1996. The total engagement rate using the Kimny guiding catheter was 91.3% (370/405). The engagement rate after the modified Kimny guiding catheter was introduced in May 1996 increased to 96.0% (243/253). The stent delivery success rate was 98.4%. We had two dislodged stents. PTCA for both left and right coronary arteries in a single procedure with the Kimny guiding catheter was performed via the radial artery in 27 patients. In 24 of these patients (89%) we engaged both coronaries successfully. In the remaining 3 patients we switched to another catheter. Except for 4 patients with non-Q-wave myocardial infarction, no major cardiac complications were encountered. No major entry site-related complications were seen, and no patient required vascular surgery or blood transfusions. In one patient the Kimny guiding catheter tip caused a minor dissection of the LMT, but no ischemic event occurred as a result. In conclusion, the Kimny device is a useful PTCA guiding catheter for routine angioplasty and stenting. Cathet. Cardiovasc. Diagn. 43:344–351, 1998. © 1998 Wiley-Liss, Inc.     

经胸壁插管气道球囊封堵治疗巨大肺脓肿

目的探讨经双路（经胸壁肺脓肿内置管、经气道球囊导管封堵肺脓肿支气管）治疗肺脓肿的新方法,并评价其疗效及安全性。方法38例肺脓肿患者随机分为两组。A组：经胸壁肺脓肿内置入中心静脉导管（导管）。B组：在A组基础上,经气道置入双腔球囊漂浮导管（球囊导管）。结果B组有效16例,A组10例,两组间疗效有显著性差异（P〈0．05）。A组并发症明显多于B组。结论经胸壁肺脓肿内置管,同时经气道置入球囊导管封堵肺脓肿引流支气管的方法,是治疗肺脓肿的一种安全和有效的新方法。     

Ablation efficacy and electrical morphology of a novel 18-hole open-irrigated catheter

Ablation Efficacy and Electrical Morphology. Introduction: The 6‐hole open‐irrigated catheter (SHOI) is increasingly used in radiofrequency (RF) ablation of arrhythmias. However, deep transmural lesions are not always achieved, and volume overload caused by irrigated ablation is another problem that should be concerned. The purpose of this study was to analyze and compare the ablation effect and electrical morphology between a novel 18‐hole open‐irrigated catheter (EHOI) and SHOI. Methods and Results: The heart was exposed through a median sternotomy in 12 anesthetized dogs, and the chest cavity was filled with heparinized saline. Bipolar contact pericardial electrograms of both catheters were recorded. Lesions were created under all permutations of the following conditions: RF energy 30 and 40 W for 60 seconds, contact force at 10, 30, and 50 g, electrode orientation horizontal to the tissue, irrigation rate 10 mL/min for EHOI and 17 mL/min for SHOI. The EHOI created deeper lesions than SHOI (5.77 ± 1.37 mm vs 4.98 ± 1.22 mm at power of 30 W, P < 0.05; 7.16 ± 1.15 mm vs 6.02 ± 1.04 mm at power of 40 W, P < 0.01), and there was a trend of larger lesion volume for EHOI (312 ± 141 mm³ vs 259 ± 108 mm³ at power of 30 W, 536 ± 200 mm³ vs 451 ± 180 mm³ at power of 40 W, P > 0.05). No significant difference in electrogram morphology between 2 catheters was detected. Conclusions: The mapping electrograms of EHOI and SHOI were not significantly different. Compared with SHOI, EHOI more effectively produced deeper lesions at a lower rate of irrigation perfusion. (J Cardiovasc Electrophysiol, Vol. 22, pp. 691‐697, June 2011)     

Reentrant Atrial Tachycardia Originating from the Superior Vena Cava

A 52-years old man with a previous pericardiotomy for idiopathic constrictive pericarditis underwent catheter ablation for drug-resistant atrial tachycardia (AT). The mechanism of the AT was considered as reentry because of resetting response and the entrainment phenomenon during AT. We introduced a 64-electrode basket catheter into the superior vena cava (SVC) during AT to obtain precise mapping. A fractionated potential preceding local atrial electrogram was recorded in the SVC. The earliest activation site of the potential was located at the anterior aspect of the SVC, 2 cm above the SVC-right atrium junction determined fluoroscopically. The fractionated potential at this site preceded the onset of the P wave by 115 msec. Radiofrequency catheter ablation at this site eliminated the tachycardia. At 6 months follow-up, the patient is free of AT. Reentrant AT involving the SVC is a candidate of RF ablation. Multielectrode basket catheter is useful for a detailed mapping of the SVC.     

Balloon mitral valvotomy by using the twin-at catheter: Immediate results and complications in 110 patients

Balloon mitral valvotomy, using a new Twin AT catheter (two balloons attached side by side over one shaft), was performed in 110 consecutive cases. The age of the patients ranged from 19–78 yr (mean 46 ± 15). From a total of 94 females and 16 males, 23 of the patients (22%) had mitral valve calcification, 47 patients (46%) had atrial fibrillation, and 39 patients (37%) had mitral regurgitation (< +2). Twenty patients (18%) presented with restenosis following surgical commissurotomy. Total catheterization time was 101 ± 26 min and the duration of the valvotomy procedure was 37 ± 21 min in these cases. For the entire population, there was a significant reduction in mitral valve gradient (15 2 6 to 4.8 ± 2.6 mmHg, p < .001), an increase in mitral valve area (MVA) (1.1 ± 0.3 to 2.35 ± 0.7 cm² ,p < .001), and a decrease in mean pulmonary arterial pressure (31 ± 12 to 26 ± 11, p <.002) after the balloon mitral valvotomy. Sixteen patients (1 4%) developed significant left to right shunt, and in 22 patients (20%) mitral regurgitation increased moderately but without resulting in emergency valve replacement. There was one incidence of embolic episode and one pericardial tamponade. Adequate hemodynamic results (MVA > 1.5 cm² and % increase in MVA ≥ 50%) without major complications were obtained in 99 cases. In 9 patients with severely diseased valve (2 previous commissurotomy, one restenosis after balloon valvotomy), or small left ventricular cavity, insufficient results were obtained by the Twin-AT catheter. The Twin-AT balloon catheter was exchanged for larger 2 balloons combinations in 5 patients and lnoue catheter in 4, and significant improvement in MVA was obtained in 5 cases. Thus, BMV can be safely and effectively performed in most cases with this new Twin-AT catheter, thereby saving time and cost. © 1993 Wiley-Liss, Inc.     

Retrieval of directional coronary atherectomy guiding catheter with angioplasty balloon catheter

Directional coronary atherectomy (DCA) has been shown to be a safe and effective treatment for occlusive coronary artery disease. We report a case of an atherectomy guiding catheter severing in two with successful retrieval of the dislodged segment by an integrated angioplasty balloon catheter system. © 1995 Wiley-Liss, Inc.