Tissue characteristics and evolution after steam pop
Tissue characteristics and evolution after steam pop
Gaetano Fassini 0 1
Sergio Conti 0 1
Gianluca Pontone 0 1
Mauro Pepi 0 1
Claudio Tondo 0 1
Antonio Dello Russo 0 1
0 Centro Cardiologico Monzino IRCCS , Milan , Italy
1 Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS , via Carlo Parea 4, 20138 Milan , Italy
Electronic supplementary material The online version of this article (doi:10.1007/s10840-015-9997-0) contains supplementary material, which is available to authorized users.
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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
13). 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).
Fig. 1 Intracardiac echocardiography: the probe is positioned in the RV
through the tricuspid valve with proper rotation of the transducer; a
truncated long-axis view of the LV is obtained. Ablation catheter at the
target area is shown in a. During RF, a growing, hyperechogenic
intramyocardial formation appears at ICE imaging (bd). After
interruption of RF, the finding disappeared within 1 min (e)
Fig. 2 Cardiac magnetic resonance: triple inversion recovery
T2weighted images of basal (a) and middle (b) short axis view of LV
showing an epicardial bright signal (white arrow) suggestive for edema
with a non-ischemic pattern. Post-contrast late gadolinium enhancement
images of basal (c) and middle (d) short-axis view of LV showing bright
signal (white arrow) in the same region of edema suggestive for epicardial
fibrosis and subendocardial focal rounded hyperenhancement surrounded
by a dark rim (red arrow) suggestive for endocardial lesion
1. Tokuda , M. , Tedrow , U. B., & Stevenson , W. G. ( 2013 ). Silent steam pop detected by intracardiac echocardiography . Heart Rhythm , 10 , 1558 - 1559 .
2. Cochet , H. , Sacher , F. , Chaumeil , A. , & Jais , P. ( 2014 ). Steam pop during radiofrequency catheter ablation: imaging features on magnetic resonance imaging and multidetector computed tomography . Circ Arrhythm Electrophysiol , 7 ( 3 ), 559 - 560 . (...truncated)