Tissue characteristics and evolution after steam pop
- 864 Downloads
KeywordsGadolinium Ventricular Tachycardia Cardiac Magnetic Resonance Late Gadolinium Enhancement Catheter Ablation
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Steam pop can lead to deep tissue disruption and potential cardiac perforation and tamponade. Intracardiac echocardiography (ICE) improves the safety of complex procedures. This is the first report in which ICE allows direct visualization of intramyocardial steam formation and the evolution over the time. Although visualization of steam pop has been described [1, 2], no direct real-time tissue change evolution was reported. A patient with monomorphic, right bundle and leftward axis, sustained ventricular tachycardia underwent catheter ablation. During radiofrequency delivery, immediately after a low-tone pop and scattered microbubble visualization, simultaneously with impedance rise, ICE showed a growing, hyperechogenic intramyocardial bubble at the catheter-tissue interface. Radiofrequency was suddenly stopped. The volume of this formation slowly decreased and completely disappeared (Fig. 1, Movie 1–3). A cardiac magnetic resonance showed, at the site of ablation, the presence of edema (T2-weighted). Post-contrast late gadolinium enhancement images showed a bright signal in the same region of edema suggestive for epicardial fibrosis and subendocardial focal rounded hyperenhancement surrounded by a dark rim suggestive for endocardial lesion (Fig. 2).
© Springer Science+Business Media New York 2015