STEREO
Ben D'Souza

VT ISCHEMIC
Build a shell
Scar focus
3 sheaths (RV, iCE cartosound L or R, 8 Fr Agilis ablation)
TS access doesnt matter much, Not so anterior - low and posterior same as PVI
Mapping with pentaray LV is hard (ectopy) and hard to steer, go with ablator set at 5 point by point
10-15 spots to see where scar is once you have scar get pentaray
10': use SR or paced as template. System will kick out ectopy
Mark mid diastolic/LP/fractionated signals with small black dots
Diurese while ablating
Drag and burn or use impedance drop/visitags
ablation at 1 in VT (1.5 in AF)
Keep cath on impedance, 50 Q, to not get steam pops
Homogeneize scar
Pace in middle of scar for exit block
Pace maps? you're still gonna torch so what's the benefit
If inducible at end use that as a template and pace ablate

AF
Still do manuals
Odyssey? Pap PVC
50 Q ant and post
all except RV free wall
Go by impedance drop not surepoint
8-10 ohms-50W- 10-12"
Persistent AF 90' PAF 60-90'
Isolate posterior wall in all persistent AF (esophageal concern) - Natale method: do posterior wall regardless of scarring
Ridge: ICE in RVOT
HPSD
1.Sound shell
2.Pentaray map
3.Ablate
4.Verify with pentaray
5.Torch entire posterior wall
Connected burn in carina first
No verification of block posterior wall
MA flutter (RSPV to MA, Bacik LSPV to MA in front of LAA)

AP
Can go map LV to LA, TS, map LV part of AP easier

CUSP PVC
Can do cusp PVCs from inferior border, can still do from superior border go up to aorta than flip vector down (not retro ao cause of vascualr access issues)
If you want to do stereo retro Ao can use Long SL1 sheath cause can't cross arch. Still hard to cross cusps
That's why you almost fget it everytime when you ablate the ventricular aspect of the cusps
If you still want to go retro ao flip vector up across then sharp vector down
Same as in PA RVPT PVCs
Give good amount then retract (like I do for CTI isthmus eustachian ridge) LV summit AMC

CS
very easy
For SUMMIT PVCs
1-RVOT
2-LVOT
3-AIV
To get in the CS get the Agilis close to the Os but not completely posterior. Move cath (second operator) then rail sheath over it.
No venogram no coronary shots (except first 10 cases) before burning in CS but usually if catheter pointing down when burning in CS you are safe and away from
coronaries in the CS
Start in the CS 20-25 W short spot burn 5-10"