What are we looking at?

 

During catheter placement and throughout the procedure, the electrophysiologist will rotate between two main x-ray angulations.

The following image are examples from my case files and are only meant for an introduction to x-ray views. The precise degree of angulation is unknown, and they are even different patients.

What is the general angulation in each image?

What catheters are observed?

How is the view helpful during a procedure?

 

 

 

Answer:

The first image is in a shallow RAO, in which the II on the c-arm (x-ray) is angled towards the patient’s right side of the body. Notice the catheter placement and it is color coded to demonstrate catheter placement in the heart model.

RAO may be helpful in differentiating between what is atrial and what is on the ventricular aspect as seen here with the dotted line running through the AV groove which corresponds with the CS catheter placement. In a more traditional RAO view the CS catheter would be more foreshortened. Notice the HRA catheter is turned back towards the SA nodal area and the RV catheter is reaching out towards the RV apex.

 

 

The second image is in LAO. In this view the His catheter and RV catheter are foreshortened as they are pointing out “towards you” in this angulation. The HRA catheter was not used in this study but was placed on the image to demonstrate what placement may look like in this view. The CS catheter is no longer foreshortened in this angulation.

The LAO view is helpful in determining what is on the left side of the heart vs the right as seen here in the illustration. In LAO, we are “looking” through the AV valves (tricuspid and mitral).