Warren Jackman's Art of War: A Sniper's Approach to Catheter Ablation-Warren Jackman’s Art of War: A Sniper's Approach to Catheter Ablation

Pdf Summary

Dr. Sunny Po discusses Dr. Warren Jackman's approach to catheter ablation, focusing on principles and techniques outlined in his book. The book covers topics such as signal processing, biophysics of radiofrequency ablation, diagnosis of tachycardia, and specific techniques for various arrhythmias. Dr. Jackman's approach is compared to that of a sniper, emphasizing careful target selection and precise execution.<br /><br />The document also includes forewords by Dr. Hugh Calkins and Dr. Hein Heidbuchel, praising Dr. Jackman's contributions and the comprehensive information in the book.<br /><br />The document then discusses the importance of minimizing noise in the EP laboratory, use of filters, and troubleshooting noise. It also explains the significance of temperature in radiofrequency ablation and the impact of electrode size, length, and orientation. The use of irrigated catheters is recommended to prevent complications.<br /><br />Differential diagnosis techniques using overdrive pacing and entrainment response are discussed, along with the importance of accurate localization in accessory pathway ablation. The challenges and techniques for ablation of septal accessory pathways and AVNRT are covered as well.<br /><br />Mapping strategies for reentrant atrial tachycardia (AT) are discussed, with activation and voltage mapping used to identify circuits and potential ablation targets. Entrainment is utilized for confirmation and further ablation guidance. The cavo-tricuspid isthmus (CTI) is a common ablation site, but voltage mapping is important to avoid high voltage areas. Differentiating AT from AF can be challenging, but mapping the coronary sinus helps with guiding ablation strategies.<br /><br />The document then explores VT ablation, including advancements in interrupting reentrant circuits and targeting abnormal potentials. The importance of accurate mapping and identification of abnormal potentials is emphasized. Substrate mapping and linear ablation may be necessary for VT associated with scar tissue. Early pre-systolic Purkinje potentials are targeted in VT originating in the left posterior fascicle. The success rate of VT ablation has significantly improved with these advancements.<br /><br />Finally, the document discusses different types of VT in patients with structural heart disease and provides insights into their mapping and ablation. LPF-VT and BBR-VT are explained, along with the ablation targets for these types of VT.<br /><br />Overall, the document provides a comprehensive overview of Dr. Warren Jackman's approach to catheter ablation, covering various aspects such as noise reduction, temperature monitoring, differential diagnosis, specific ablation techniques for different arrhythmias, mapping strategies, and advancements in VT ablation.

Asset Subtitle

Sunny S. Po, MD, PhD

Keywords

catheter ablation

Dr. Warren Jackman

signal processing

diagnosis of tachycardia

arrhythmias

sniper approach

noise reduction

temperature monitoring

differential diagnosis

mapping strategies