Jugular Vein Intracardiac Echocardiography-Guided Percutaneous Transluminal Septal Myocardial Ablation: A Novel Approach in 4 Cases.

OBJECTIVE

This study sought to describe a novel technique for percutaneous transluminal septal myocardial ablation using intracardiac echocardiography (ICE) through the right internal jugular vein (JV) in patients with hypertrophic obstructive cardiomyopathy.

KEY STEPS

Prepare the equipment and establish vascular access, insert the JV ICE catheter using a sterile sleeve, perform initial screening with JV ICE to obtain key cardiac views, identify target septal branch using coronary angiography and JV ICE, monitor contrast injection and ethanol administration in real time with JV ICE, continuously assess for immediate complications, and evaluate postprocedure gradient reduction and ablation efficacy.

POTENTIAL PITFALLS

Risks include vascular complications, arrhythmias, cardiac tamponade, embolism, and infections. JV ICE requires specific skills, presenting a learning curve. Mitigation strategies involve ultrasound-guided access, careful catheter manipulation, strict asepsis, comprehensive training, optimized settings, and continuous monitoring.