Accuracy of Fluoroscopic Localization of the Crista Terminalis Documented by Intracardiac Echocardiography

The crista terminalis is an important anatomic target for ablation of atrial arrhythmias. We determined the accuracy of catheter placement guided by fluoroscopy alone when directed to 24 sites along the crista terminalis in 6 patients. The sites selected included the most medial superior, most lateral superior, mid lateral, and most inferolateral sites along the crista terminalis in each patient. These sites were selected because of their recognized importance in sinus node and/or atrial tachycardia ablation and the importance of avoiding caval structures when targeting the most superior and/or inferior right atrium. The position of the catheter tip was documented using a catheter based ultrasound transducer in the right atrium or vena cava. The operator was blinded to the intracardiac echocardiographic (ICE) results until reviewing the images after the procedure in each patient.