IBHRE Ablation Procedures and Techniques 2 — Questions and Answers
Question 1: Which serious complication is uniquely associated with transseptal puncture for left-sided EP procedures?
- Pneumothorax
- Complete heart block
- Cardiac tamponade from aortic or atrial perforation (Correct answer)
- Lead dislodgement
Correct answer: Cardiac tamponade from aortic or atrial perforation
Transseptal puncture to access the left atrium carries risk of cardiac tamponade if the needle inadvertently perforates the aorta, atrial free wall, or pericardium.
Question 2: What is the primary purpose of electroanatomic mapping systems in catheter ablation?
- To measure intracardiac blood pressure
- To create 3D maps integrating anatomical and electrical activation data (Correct answer)
- To monitor systemic oxygen saturation
- To deliver internal defibrillation
Correct answer: To create 3D maps integrating anatomical and electrical activation data
Electroanatomic mapping systems create three-dimensional maps combining chamber anatomy and electrical activation to guide catheter positioning and ablation targeting.
Question 3: Contact force sensing catheters improve ablation outcomes by?
- Reducing patient radiation exposure
- Measuring the force applied between catheter tip and tissue (Correct answer)
- Preventing thrombus formation on the catheter
- Increasing the mapping point acquisition speed
Correct answer: Measuring the force applied between catheter tip and tissue
Contact force sensing directly measures the mechanical force applied to cardiac tissue, enabling more consistent lesion formation and reducing perforation risk.
Question 4: During VT ablation, substrate mapping primarily identifies?
- Normal sinus node tissue to preserve
- Low-voltage scar areas harboring abnormal electrograms that sustain VT (Correct answer)
- Healthy myocardium to target for ablation
- Pulmonary vein triggers causing VT
Correct answer: Low-voltage scar areas harboring abnormal electrograms that sustain VT
Substrate mapping identifies low-voltage scar tissue and late/fragmented electrograms that form the critical conducting channels sustaining ventricular tachycardia circuits.
Question 5: The primary purpose of open-irrigated tip catheters in RF ablation is?
- To increase lesion surface temperature
- To allow larger, deeper lesions by preventing surface char formation (Correct answer)
- To reduce total procedure time
- To eliminate the need for electroanatomic mapping
Correct answer: To allow larger, deeper lesions by preventing surface char formation
Saline irrigation cools the catheter-tissue interface, preventing char and coagulum formation and allowing delivery of higher power to create larger, deeper lesions.
Question 6: The risk of atrioesophageal fistula, a rare but potentially fatal complication, is most associated with?
- Right-sided ablation procedures
- Posterior left atrial ablation for atrial fibrillation (Correct answer)
- Cavo-tricuspid isthmus ablation
- AVNRT slow pathway ablation
Correct answer: Posterior left atrial ablation for atrial fibrillation
The esophagus lies directly behind the posterior left atrium, making it vulnerable to thermal injury during posterior wall ablation for atrial fibrillation.
IBHRE Ablation Procedures and Techniques 2
Which serious complication is uniquely associated with transseptal puncture for left-sided EP procedures?