Left ventricular perforation in a patient with a left ventricular aneurysm during NOGA® catheter mapping

• Published in: Cardiovascular revascularization medicine Vol. 19; no. 8; pp. 50 - 52
• Main Authors: Sharma, Gaurav K., Poulin, Marie-France, Schaer, Gary L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2018
• Subjects: Left ventricle aneurysm; Left ventricular perforation; NOGA® catheter; RENEW clinical trial; RAO; Left ventricular perforation; CCS; TTE; RENEW clinical trial; Left ventricle aneurysm; NOGA® catheter; LV; LAO; CABG
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2017.05.011

Endocardial mapping of the left ventricle (LV) using the NOGA® XP Cardiac Navigation System can identify chronically ischemic and viable myocardium in patients with coronary artery disease by generating electromechanical maps. These maps are very useful when targeting myocardial tissue for injection of stem cells. We present the case of a woman who developed a perforation at the site of an LV aneurysm during NOGA mapping prior to the transendocardial injection of stem cells, as part of a multicenter clinical trial. The presence of an LV aneurysm is currently not a contraindication (or caution) to the use the NOGA mapping catheter. As the field of stem cell therapy evolves and the use of this technique increases, operators must be aware that the presence of an LV aneurysm may increase the risk of perforation during a NOGA mapping procedure.
•In clinical trials, endocardial mapping using the NOGA® XP Cardiac Navigation System is used to identify ischemic and viable myocardium in patients with coronary artery disease to guide the injection of stem cells or gene products.•The presence of an LV aneurysm from a prior myocardial infarction may represent a site within the LV at greater risk for perforation with manipulation of the relatively stiff NOGA catheter.•Therefore, greater caution is warranted during NOGA mapping in patients with an LV aneurysm.