Introduction to AF Ablation

Description :This video is courtesy of Dr. Dhanunjaya Lakkireddy, Director of the Center for Excellence in Atrial Fibrillation at the University of Kansas Hospital, Kansas City, KS. The narration is by Caroline Murray. This is what you can expect as you are rolled in from the preparation room to the electrophysiology lab. Many patients find those few minutes rolling through empty hallways to be a very anxious time. It is important to remain positive and know that you are in capable hands. You can see Dr. Lakkireddy, scrubbed and ready in the case. The instruments that are used in the procedure are laid out on the short table in front of us. There is a patient draped and ready for the procedure. You will see several monitors hanging around you. These monitors display the x-ray (or fluoroscopic) images of your heart, along with the electrical activity inside your heart. Small vascular sheaths that look like tubes are used from both sides of the groin to gain access to your heart. These short sheaths will later be exchanged for longer transseptal sheaths that help in gaining access to the wall separating the upper chambers of your heart (called the interatrial septum) and then to the left upper chamber where the bulk of the procedure is done. A short needle mounted on a syringe is used to gain access to the blood vessels in the groin, in this case a large central vein called the femoral vein that traverses the groin. This vein joins the other veins to form the inferior vena cava; this vessel later joins the right upper chamber of the heart. It is through the femoral vein on both sides of the groin that we place various catheters that aid in the procedure. Once access to the femoral vein is obtained, a short, flexible guide wire is passed through the needle into the vessel over which the vascular sheath is placed (this is called the Seldinger technique) Once all the sheaths are prepared and the patient is draped, you will see one of the procedure assistants called the operator) feeling both sides of the groin, to find the femoral arterial pulse. This pulse acts as the landmark for showing the course of the femoral vein. Usually the femoral vein lies close to the femoral artery. You may wonder how the sheath crosses from one chamber to the other when they are separated by a wall. This is where the long, thin steel needle Dr. Lakkireddy is holding is used. This is called the transseptal (or Brockenborough) needle; it is placed inside the long transseptal sheath to puncture the septal wall that separates the right and left upper chambers of the heart.