ESOPHAGEAL SIGNALS AS REFERENCE GUIDE FOR ABLATIONS IN CONGENITAL HEART DISEASES
Despite technological advances in the field of catheter ablation and mapping system, there can be some limitations and challenges especially in congenital heart disease due to complexity of anatomy. In complex cardiac anatomy such as heterotaxia syndromes, chambers of heart, great vessels and structures such as coronary sinus may pose problems as they are not located where they used to be [1]. Vascular access is another challenge beside this complex anatomy, and arrhythmia mechanisms. During electrophysiological studies and ablation procedures reference signal keeps its importance in respect to recent developments of technology of mapping systems. A stable reference signal is mandatory in all cases. In such cases due to limitations of vascular access and size of the pediatric patients, additional catheter for intracardiac electrograms cannot be placed in atria stable position. Due to stability and gaining both atrium and ventricular signals, coronary sinus is the most convenient place for reference catheters. The quadripolar catheters used for the transesophageal electrophysiological study is an alternative in such cases. Since the esophagus is in an anatomical position close to the left atrium, signals acquired from esophagus have both atrial and ventricular signals. In addition to acquiring stable signals from atria and ventricle, it can also be used to stimulate the atria [2, 3].
To aim of this article is to report the effectiveness of transesophageal electrode as a reference catheter in patients with limited vascular access and complex congenital heart disease during ablation procedures.