UCD Cryo A-fib

Open

• EP Pack
• Flexcath
• 28mm Arctic Advance
• Probe Cover
• 2 - Ice Cover - Shockwave
• Copilot
• Manifold + dump bag
• Smart Ablate Tubing
• Micropuncture
• 20ml syringes 2-4
• A-line set
• Pressure transducer kit x3
• 7F locking
• 8F locking
• 8.5 Non-locking
• 6fr CRD 2 quad

Pezeshkian	Srivatsa	Cortez	Munir
Stockroom
Versacross D0	Versacross D1
Soundstar 10Fr	Soundstar 8Fr
DecaNav D	DecaNav F
Lab
Octaray D 2-2-2	Octaray F 3-3-3
Dynamic XT steerable quad	CRD 2 Quad
Achieve 20mm	Achieve 15mm
Long 11Fr	Long 9Fr
14fr non-locking	Zero Gravity drape
Standby	If needed for touch up post cryo or for redo afib.
Smart touch thermocool STSF DF	Smart touch thermocool ST FJ
	Perclose x1 Vascade x3

Cables

• Achieve cable
• Electrical umbilical cable
• Coaxial umbilical cable
• DecNav cable
• Pentaray cable
• Quad cable x 2
• Abalator cable

Procedure (tech)

Pre

Read UCD EP Role for pre and post procedural steps.

• Include CMAP when patching for phrenic pacing
  • Cable located in C block #31-32
  • Attach alligator clips to patches
• Set up pressure lines
  • Double spike Hep saline bag under pressure
  • Flush and connect blue pressure to transducer closest to patient on rack (P1)
• Zero A-line
• Assist with hooking up
  • Vascular US
  • EP cables
    • Achieve to pin block Blue 1-10
    • Deca nav to Deca
    • His Quad to Quad B (OK to unplug pin block quad plug)

During case

• Open ablation window on live screen
  • right click in ablation window to change ablator.
  • Check dial for correct ablator.
• Check that ablation switch behind ablation consoles is set to "Cryo"
• Physician will place catheters and access LA.
• Be ready for backup pacing post cardioversion (usually HisD)
• Measure LA pressure
• Measure conduction intervals
• Once Cryo ballon is in LA and ablation starts do the following:
  • Save and label freeze frame of fluoro with location of freeze and ablation number ex: "LUPV Cryo #1" copy this text and save
  • Monitor ablation sequence
  • After ablation ends, record ablation data including copied text to Ablation End log entry comment section ex: "LUPV Cryo #1 180sec -45C"
    • If esophagus temp is affected, record this temp also "23C esoph"
  • EP study is conducted during Cryo ablation phase of procedure
    • Atrial Wenckebach, Atrial ERP, and VERP
  • When phrenic nerve is involved. Prepare to pace CMAP
    • Channel 4 800msec, 25mA
    • When freeze is initiated, come on pacing as temp passes 0C
    • When thawing, come off pacing as temp passes 0C

Procedure (scrub)

Pre

• Label pressure lines
  • Blue - Transseptal line connected to P1. Swapped to manifold during cryo ablation.
  • Yellow - not transduced connected to flex cath sheath.
  • No color - used for Octaray drip. Keep manifold on table.
  • A-line setup. Pre labeled red. Connects to sheath for act draws.
• Setup manifold
  • Cap 2 middle ports for Srivasta. No dump bag
  • Position 1 connects to blue pressure line.
• Position 4 pass off spike for pressurized saline.