scholarly journals Novel noncontact charge density map in the setting of post-atrial fibrillation atrial tachycardias: first experience with the Acutus SuperMap Algorithm

2020 ◽  
Author(s):  
Robbert Ramak ◽  
Gian-Battista Chierchia ◽  
Gaetano Paparella ◽  
Cinzia Monaco ◽  
Vincenzo Miraglia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Resolution ◽  
Charge Density ◽  
Pulmonary Vein ◽  
The Novel ◽  
Mapping Algorithm ◽  
Af Ablation ◽  
High Resolution Mapping ◽  
Resolution Mapping ◽  
The Mean

Abstract Purpose The purpose of this study was to evaluate the safety and feasibility of the new high-resolution mapping algorithm SuperMap (Acutus Medical, CA, USA) in identifying and guiding ablation in the setting of regular atrial tachycardias following index atrial fibrillation (AF) ablation. Methods Seven consecutive patients who underwent a radiofrequency catheter ablation guided by the novel noncontact charge density (CD) SuperMap for atrial tachycardia were prospectively enrolled in our study. Results Arrhythmogenic substrate was identified in all seven patients. Mean number of EGM per map was 5859.7 ± 4348.5 points. Three patients (43%) exhibited focal tachycardia mechanisms in the left atrium, alternating from anteroseptal right superior pulmonary vein (RSPV), posterior in proximity of left inferior pulmonary vein (LIPV), and interarial septum in proximity of fossa ovalis, respectively. Four patients exhibited macroreentrant mechanism. In 3 of these patients, SuperMap detected mitral isthmus-dependent flutters with tachycardia cycle lengths of 240, 270 and 420 ms, respectively. In one patient, the mechanism was a macroreentrant tachycardia with the critical isthmus located between the crista terminalis and atriotomy. The mean ablation time (min) was 18.2 ± 12.5 and the mean procedural duration time was 56.4 ± 12.1 min. No minor or major complications occurred. Conclusion The novel high-resolution mapping algorithm SuperMap proved to be safe, fast, and feasible in identifying and guiding ablation in the setting of regular atrial tachycardias following index AF ablation.

Pulmonary vein-gap re-entrant atrial tachycardia following atrial fibrillation ablation: an electrophysiological insight with high-resolution mapping

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1039-1047 ◽  
Author(s):  
Seigo Yamashita ◽  
Masateru Takigawa ◽  
Arnaud Denis ◽  
Nicolas Derval ◽  
Yuichiro Sakamoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Resolution ◽  
Pulmonary Vein ◽  
Atrial Tachycardia ◽  
Atrial Fibrillation Ablation ◽  
P Wave ◽  
Conduction Time ◽  
High Resolution Mapping ◽  
Mapping System ◽  
Resolution Mapping

Aims The circuit of pulmonary vein-gap re-entrant atrial tachycardia (PV-gap RAT) after atrial fibrillation ablation is sometimes difficult to identify by conventional mapping. We analysed the detailed circuit and electrophysiological features of PV-gap RATs using a novel high-resolution mapping system. Methods and results This multicentre study investigated 27 (7%) PV-gap RATs in 26 patients among 378 atrial tachycardias (ATs) mapped with Rhythmia™ system in 281 patients. The tachycardia cycle length (TCL) was 258 ± 52 ms with P-wave duration of 116 ± 28 ms. Three types of PV-gap RAT circuits were identified: (A) two gaps in one pulmonary vein (PV) (unilateral circuit) (n = 17); (B) two gaps in the ipsilateral superior and inferior PVs (unilateral circuit) (n = 6); and (C) two gaps in one PV with a large circuit around contralateral PVs (bilateral circuit) (n = 4). Rhythmia™ mapping demonstrated two distinctive entrance and exit gaps of 7.6 ± 2.5 and 7.9 ± 4.1 mm in width, respectively, the local signals of which showed slow conduction (0.14 ± 0.18 and 0.11 ± 0.10m/s) with fragmentation (duration 86 ± 27 and 78 ± 23 ms) and low-voltage (0.17 ± 0.13 and 0.17 ± 0.21 mV). Twenty-two ATs were terminated (mechanical bump in one) and five were changed by the first radiofrequency application at the entrance or exit gap. Moreover, the conduction time inside the PVs (entrance-to-exit) was 138 ± 60 ms (54 ± 22% of TCL); in all cases, this resulted in demonstrating P-wave with an isoelectric line in all leads. Conclusion This is the first report to demonstrate the detailed mechanisms of PV-gap re-entry that showed evident entrance and exit gaps using a high-resolution mapping system. The circuits were variable and Rhythmia™-guided ablation targeting the PV-gap can be curative.

scholarly journals Regional entrainment of atrial fibrillation studied by high-resolution mapping in open-chest dogs.

Circulation ◽  
1993 ◽  
Vol 88 (2) ◽  
pp. 736-749 ◽  
Author(s):  
C Kirchhof ◽  
F Chorro ◽  
G J Scheffer ◽  
J Brugada ◽  
K Konings ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Resolution ◽  
High Resolution Mapping ◽  
Open Chest ◽  
Resolution Mapping

Abstract 16342: Feasibility and Safety of Intra-operative Mapping for Diagnosis of the Substrate of Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Lisette van der Does ◽  
Ameetha Yaksh ◽  
Charles Kik ◽  
Paul Knops ◽  
Frans Oei ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mean Arterial Pressure ◽  
High Resolution ◽  
Arterial Pressure ◽  
Right Atrial ◽  
Epicardial Mapping ◽  
High Resolution Mapping ◽  
Mapping Approach ◽  
Resolution Mapping ◽  
Atrial Mapping

Introduction: Multi-site, high-resolution mapping can be used to identify either the trigger or substrate perpetuating atrial fibrillation (AF). The goal of this study was to assess the feasibility and safety of a new high-resolution epicardial mapping approach. Hypothesis: Epicardial atrial mapping of the entire atria can be safely performed as a routine procedure during cardiac surgery. Methods: Epicardial mapping of the entire right atrium, left atrium and Bachmann’s Bundle was performed in 291 patients (218 male, age:66±11yrs) undergoing elective surgery during sinus rhythm (SR) and (induced) AF using high-resolution mapping arrays with inter-electrode distances of 1-2mm. Electrophysiological parameters were quantified and designated to anatomical quadrants of 1cm2. Results: AF was non-inducible in 36 patients. Hemodynamic parameters (mean arterial pressure, right atrial pressure, BIS score, ST-T segment alterations) before and during SR mapping were comparable (P<0.22). During AF, only mean arterial pressure (71±11 versus 67±10mmHg (P<0.004)) and right atrial pressure (10±4 versus 11±4mmHg (P<0.0001)) decreased. Total mapping time during SR or AF was respectively 3±1min. and 4±2min. Beat-to-beat variation of SR cycle length and peak-to-peak amplitude of unipolar potentials were respectively 0.04±14.42ms and -0.01±0.53mV, reflecting stability of the mapping array. Complications were not observed. Conclusions: Our novel intra-operative epicardial atrial mapping approach can be safely applied during both SR and AF. This mapping approach is the first technique allowing quantification of the arrhythmogenic substrate in the individual patient thereby taking the first step towards personalizing treatment of AF.

Correlative High-Resolution Mapping of Strain and Charge Density in a Strained Piezoelectric Multilayer

2014 ◽  
Vol 2 (1) ◽  
pp. 1400281 ◽  
Author(s):  
Kyung Song ◽  
Christoph T. Koch ◽  
Ja Kyung Lee ◽  
Dong Yeong Kim ◽  
Jong Kyu Kim ◽  
...  
Keyword(s):  
High Resolution ◽  
Charge Density ◽  
High Resolution Mapping ◽  
Resolution Mapping

scholarly journals Initial clinical experience of pulmonary vein isolation using the novel ultra-low temperature cryoablation catheter for patients with atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Tohoku ◽  
S Bordignon ◽  
S Chen ◽  
B Schmidt ◽  
K R J Chun
Keyword(s):  
Atrial Fibrillation ◽  
Low Temperature ◽  
Pulmonary Vein ◽  
Cooling Power ◽  
The Novel ◽  
Funding Sources ◽  
Initial Application ◽  
First Pass ◽  
The Mean ◽  
Ischemic Attack

Abstract Background The high cooling power and ultra-low temperature cryoablation (ULTC) catheter called “Adagio” has been recently launched. A combination of a newly exploited cryogen and interchangeable stylet enables flexible and continuous lesion creation applicable not only for atrial fibrillation (AF) but also for other tachyarrhythmia by optimizing catheter shape. The exclusive esophageal warming balloon in order to preserve esophageal temperature is encouraged to prevent the potential risk of esophageal complication during procedure. Aim To assess the initial clinical data on pulmonary vein (PV) isolation for patients with AF using the novel ULTC catheter. Methods Consecutive patients who underwent AF ablation using ULTC in our center were enrolled. We assessed the acute procedural data focusing on procedural feasibility and safety comprising “first-pass isolation” defined as successful PV isolation after the initial application. Results A total of 16 AF patients (53% male, age 67 years, 59% paroxysmal AF) were analyzed. Sixty-six out of 67 PVs (98.5%) were isolated with ULTC. The mean number of applications per PV was 2.3 1.1. Touch-up catheter was needed in one case at left inferior PV. The mean total procedure and fluoroscopy times were 79±30 and 14±7 mins, respectively. First-pass isolation was achieved in 34 PVs (50.7%) varying across PVs from left superior PV (43.8%) to right superior PV (58.8%). In none of the patients an acute thromboembolic event (stroke or transient ischemic attack), a pericardial effusion/tamponade and postprocedural esophageal complication occurred. A single transient phrenic nerve weakening was observed at right superior PV. Conclusion Sequential PV isolation using the novel ULTC catheter was achieved feasibly without compromising safety. First-pass isolation was accomplished about in a half of PVs. FUNDunding Acknowledgement Type of funding sources: None.

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