EP Lesson 7/8/9 - Vascular Access/Access Chambers of Heart/Diagnostic Catheters

common access sites of the heart

right and left femoral vein, right and left femoral artery, right subclavian vein, and right internal jugular vein

femoral vein access purposes

obtain vascular access, administer hemodialysis, cardiac cath, administer large infusions

NAVEL anatomy acronym

femoral nerve, artery, vein, empty space, lymphatics

lateral to medial

vascular closing techniques

manual compression, passive closure devices, active closure devices, figure 8 suture

superior access pathway

right internal jugular vein, subclavian vein, superior vena cava, RA

retrograde approach

left side of the heart is accessed through the arterial system

inferior access sites for right side

right femoral

sheaths and caths access for right side

right and left femoral

superior access on the right side

right jugular, left subclavian, left anticubital

superior access sites

right internal jugular or subclavian vein

inferior access sites / what type of ablation

right femoral vein / cavotricuspid isthmus ablation

two ways to access the left side of the heart

retrograde and transseptal approach

retrograde approach

left side of heart is accessed through arterial system > right femoral artery all the way to aortic valve then mitral valve which gives access to LA

transseptal approach / common for what procedure

right femoral vein > fossa ovalis > LA

pulmonary vein isolation and LA arrythmias

The structures in the immediate vicinity of the interatrial septum are

Left atrium

Aorta

Pericardium

Coronary sinus ostium

The thinnest part of the interatrial septum is the __________

fossa ovalis

transseptal puncture steps

1. Long guidewire positioned in the SVC

2. Transseptal sheath and dilator advanced over the guidewire into SVC

3. Guidewire removed, needle inserted into sheath without exiting dilator

4. System is pulled down to engage fossa ovalis

5. Confirm transseptal location and perform transseptal puncture with needle

6. Holding needle in place, advance sheath and dilator assembly into left atrium

7. Remove needle and dilator while maintaining sheath position in the left atrium.

   1. Aspirate and flush the transseptal sheath per hospital protocol

Diagnostic EP catheters are named for their number of what

electrodes

josephson catheter used in what locations

HRA, His bundle, RVA (right ventricular apex)

cournand catheter used in what locations

His bundle

Damato catheter used in what locations

right ventricular apex

HRA cath type and path

A fixed curve quadripolar catheter is advanced from the femoral vein with the tip in contact with the lateral wall near the SVC/RA junction.

RVA cath type and path

A quadripolar catheter is advanced from the femoral vein with the tip placed as close as possible to the right ventricular apex.

HBE cath type and path

A curved or shaped quadripolar catheter is advanced from the femoral vein to a position that straddles the tricuspid annulus in its superior position.  At the correct position, a His bundle electrogram should be seen between the atrial and ventricular electrograms.

CS cath type and path

A multipolar (usually 8 or 10 poles) electrode catheter is advanced either from the femoral, internal jugular, or subclavian vein into the coronary sinus so that the distal tip is in a left lateral position and the proximal poles are close to the CS ostium.