High-density versus low-density mapping in ablation of atypical atrial flutter

2021 ◽  
Author(s):  
J. C. Balt ◽  
M. N. Klaver ◽  
B. K. Mahmoodi ◽  
V. F. van Dijk ◽  
M. C. E. F. Wijffels ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
High Density ◽  
Low Density ◽  
Density Mapping

scholarly journals Clinical impact of high density mapping in atypical atrial flutters ablation: outlining critical circuits in complex atrial tachycardias

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Di Cori ◽  
L Mazzocchetti ◽  
M Parollo ◽  
S Della Volpe ◽  
V Barletta ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Atrial Flutter ◽  
Clinical Impact ◽  
High Density ◽  
Mapping Technique ◽  
Low Density ◽  
Single Center ◽  
Density Mapping ◽  
Procedural Outcomes

Abstract Introduction Mapping and ablation of atypical atrial flutter (AFL) continue to be a challenge for clinical electrophysiologists. The advent of high-density (HD) mapping has allowed the generation of electro-anatomic maps with a very high resolution level. Purpose In this single center retrospective analysis, we evaluated the clinical impact of the ultra HD activation sequence mapping compared with the standard low density (LD) ablation catheter mapping technique in the treatment of AFLs. Methods We performed a 7 years-single center retrospective analysis of patients undergoing radiofrequency ablations (RFA) for right and left atypical AFL. We evaluated procedural and clinical outcomes of patients approached with a Low Density (LD) electro-anatomical (EAM) strategy compared with patients mapped with new automatic multipolar HD Mapping (HD Group). Results Seventy-five patients were included. Patients were almost male (60%), relatively old (65±8 years), with a moderate CHA2DS2Vasc score (2.3±1.3), a preserved ejection fraction (58±6) and moderate atrial dilatation (44±7 mm). Baseline clinical characteristics were comparable between groups (p=NS). Among 88 AFLs, 10 (11%) were located in the right and 78 (89%) in the left atrium, including 22 (28%) roof dependent and 37 (47%) mitral dependent (p=NS). Regarding procedural outcomes, Sinus rhythm restoration during ablation was more frequently observed in the HD Group (79% vs 56%, p=0.037), even if no differences in mapping time, procedural time and radiological dose were observed (p=NS). Freedom from AFL/atrial fibrillation (AF) at 1-year was lower in the HD Group (83% vs 45%, p=0.009) with an increased trend for AF recurrences during long term follow-up (17% vs 23% at 1 and 3-years respectively, p=0.059). At the multivariate analysis, HD map (OR 0,17; 95% CI 0,04–0,66) and younger age (OR 1,09; 95% CI 1,01–1,19) were identified as independent predictors of ablation success at 1 year. Conclusions Acute procedural success of ablation of atypical atrial flutter is higher in case of HD mapping strategy. Patient age and HD strategy resulted independent predictors of overall atrial arrhythmias recurrences. During follow-up, AFL recurrences are rare beyond 12 months, differently from AF which continues to show increasing trends. FUNDunding Acknowledgement Type of funding sources: None. Procedural outcomes Atypical atrial flutter HD map

scholarly journals P1386Typical atrial flutter circuit characterization using ultra-high density mapping

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii272-iii272
Author(s):  
SS. Bun ◽  
DG. Latcu ◽  
T. Delassi ◽  
A. Al Amoura ◽  
B. Enache ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
High Density ◽  
Density Mapping

231Local impedance-guided ablation and ultra-high density mapping provide improved ablation metrics vs conventional or contact force-guided ablation for cavotricuspid isthmus dependent atrial flutter

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Saraf ◽  
G M Morris
Keyword(s):  
Atrial Flutter ◽  
Contact Force ◽  
Cost Savings ◽  
High Density ◽  
Patient Specific ◽  
Procedure Time ◽  
Potential Cost ◽  
Cavotricuspid Isthmus ◽  
Density Mapping

Abstract INTRODUCTION. Radiofrequency ablation (RFA) of cavotricuspid isthmus dependent atrial flutter (CTI-AFL) can be performed with fluoroscopy (Fluo) or 3-dimensional (3D) electroanatomic mapping and contact force (CF) catheters. Local impedance (LI) is an alternative but no comparisons have yet been made. METHODS. An observational study comparing Fluo, CF- and LI-guided RFA for CTI-AFL. In the LI group, if CTI block was not obtained after initial ablation, ultra-high density mapping (UHDm) was used to identify breakthrough sites. Contact was determined using patient specific LI; RF delivered until 20 ohm LI drop seen, or LI drop plateaued >2 secs. In the CF group 10-40g force was used. Power was limited to 40-50W in all groups. Total RFA time, time from RFA start to CTI block, no. of lesions required to achieve block, acute success, complications and re-ablation during follow-up were analysed using ANOVA. RESULTS. Data presented for 24 patients (7 Fluo, 7 CF, 10 LI). Mean RFA time: 6.6, 5.9, 3.2 min respectively (p = 0.0478). Statistically significant differences also seen with LI vs Fluo (p = 0.0451) and LI vs CF (p = 0.0313). Time from first RFA to block: 25.5, 19.8, 14.2 min (p = 0.5688); number of lesions to achieve block: 8.5, 10.3, 8 (p = 0.3909). 100% success and no complications in all groups. 0% need for re-ablation (16.3 ± 7, 12.6 ± 8, 6.5 ± 4.4 months follow-up). DISCUSSION. This data illustrates that UHDm and LI-guidance significantly reduces the amount of CTI RFA, by 52% and 47% vs Fluo and CF respectively (p = sig, fig. 1). A reduction from first RFA to block is also seen (43% and 37%; p = ns, fig. 2). Given no difference in the no. of lesions, LI-guided RFA during lesion formation shortens the duration of each lesion. Many patients require further RFA (+/- mapping) if they do not achieve block following the initial ablation line, resulting in longer procedures. Several patients without block in the LI group underwent repeat UHDm, which quickly identified CTI or epicardial-endocardial breakthrough (fig. 3 & 4), allowing rapid targeting for re-ablation. In the fluo group, these procedures would often be significantly prolonged, meaning extensive RFA and radiation exposure. Fig. 1 shows smaller error bars with LI compared to the others, resulting in more predictable total ablation times; this could potentially benefit procedure scheduling (more procedures per unit time). We could not directly compare overall procedure time as many in the CF group had CTI RFA combined with left atrial RFA. Multiple LI cases were performed fluo-free with only magnetic tracking. This may allow case scheduling without a radiographer, with potential cost savings. CONCLUSION. LI-guided CTI-AFL RFA is safe and effective and has shown favourable ablation metrics compared to Fluo or CF-RFA. LI-RFA with UHDm more quickly and accurately identifies breakthrough and with fluoro-free technique could possibly reduce procedure time and cost. A larger study is planned to provide more insight. Abstract Figures

scholarly journals P926Preliminary experience of maximum voltage-guided approach with a novel ultra-high density mapping system for atrial flutter ablation

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii186-iii186
Author(s):  
G. Maglia ◽  
F. Arabia ◽  
V. Aspromonte ◽  
A. Mignano ◽  
M. Candigliota ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
High Density ◽  
Density Mapping ◽  
Mapping System ◽  
Maximum Voltage ◽  
Atrial Flutter Ablation

1321From high-density mapping to low-density mapping: an approach to delineate the active circuit in complex atrial reentrant tachycardias

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Alonso ◽  
E Rodriguez Font ◽  
J Guerra Ramos ◽  
B Campos Garcia ◽  
F Mendez Zurita ◽  
...  
Keyword(s):  
Structural Heart Disease ◽  
High Density ◽  
Low Density ◽  
Activation Patterns ◽  
Density Mapping ◽  
Atrial Ablation ◽  
Active Circuit ◽  
The Right ◽  
Activation Map ◽  
Mapping Systems

Abstract Funding Acknowledgements NA OnBehalf NA Background High-density activation maps during complex atrial reentrant tachycardias are challenging to interpret as they include the activation patterns of active and passive circuits. Entrainment mapping provides the identification of the active tachycardia circuit. However, current electroanatomic mapping systems are not capable to color-coded the information obtained from entrainment maneuvers. Objectives  We sought to describe a mapping approach for ablation of complex atrial reentrant tachycardias in which high-density activation maps are transformed into low-density activation maps only displaying the active part of the tachycardia circuit. Methods We included consecutive patients with atypical atrial flutter. A high-density activation map was acquired during the index tachycardia. Subsequently, entrainment maneuvers were performed to generate a low-density activation map in which only the activation of the atria directly involved in the flutter circuit was displayed. Results  Seventeen patients were included 82%  male, mean age was 62 ± 7 years. Structural heart disease was present in 59% and 53% had a prior left atrial ablation procedure. Low-density activation maps were successfully generated from an average of  14 ± 3 entrainment points. Twenty circuits (95%) were identified in the left atrium and 1 (5%) in the right atrium. Ablation guided by low-density mapping successfully terminated all ARTs in 267 ± 353 seconds of radiofrequency application. Conclusion Low-density mapping based on entrainment maneuvers provides a precise delineation of the active circuit during complex ARTs and resulted in successful arrhythmia termination. This approach can be easily incorporated into clinical practice.

scholarly journals Influence of zones of low-amplitude activity on the mechanism and treatment of atrial arrhythmias.

2021 ◽  
Author(s):  
Elizaveta Dedukh ◽  
Elena Alexandrovna Artyukhina
Keyword(s):  
Atrial Flutter ◽  
Heart Surgery ◽  
Clinical Observation ◽  
High Density ◽  
Interventional Treatment ◽  
Atrial Arrhythmias ◽  
Density Mapping ◽  
Rf Exposure ◽  
Low Amplitude

Abstract: A clinical case of interventional treatment of a patient with atypical atrial flutter who has not previously undergone surgical or interventional heart surgery. This clinical observation demonstrates the role of common zones of low-amplitude activity on the mechanism and treatment of atrial arrhythmias. Widespread areas of low-amplitude activity in the left atrium can create barriers to the propagation of excitation, which can cause atypical atrial flutter. High density mapping will help visualize the mechanism of this arrhythmia. Understanding the mechanism of atypical atrial flutter will help minimize RF exposure during treatment. Key words: high density mapping; atypical atrial flutter; atrial fibrosis; radiofrequency ablation.

scholarly journals Successful case of complex atrial flutter occurring in a patient with congenitally corrected transposition of the great arteries, aberrant left atrial appendage, and situs inversus

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Feng Hu ◽  
Erpeng Liang ◽  
Lihui Zheng ◽  
Ligang Ding
Keyword(s):  
Atrial Flutter ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
High Density ◽  
Atrial Appendage ◽  
Transposition Of Great Arteries ◽  
Density Mapping ◽  
Successful Ablation ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition

Abstract Background Congenitally corrected transposition of great arteries (ccTGA) is a rare congenital cardiac defect with atrioventricular and ventriculoarterial discordance which leads to heart failure and limits patients’ lifespan. The extremely aberrant cardiac structure makes electrophysiological procedure and radiofrequency ablation very difficult to be performed in such patients. Until now, there were only sporadical cases that have reported the successful ablation of atrial flutter in ccTGA patients. Case presentation We report a case of a 36-year-old male who was diagnosed with dextrocardia, atrial septal defect and congenitally corrected transposition of great arteries (ccTGA) at a young age and received atrial septal defect repair and morphological tricuspid valve plasty in 2014. As for reasons of heart failure and atrial flutter, he frequently suffered from progressively worsening dyspnea and recurrent episodes of palpitations. Cardiac anatomic imaging reconstruction before electrophysiological test revealed an unusually huge left atrial appendage in this patient. After high-density mapping of both right atrium and left atrium, activation mapping showed reentry circuit loops were located in left atrium. Successful ablation strategy was performed under the guidance of high-density mapping and entrainment. Conclusion This is a clinical case showing high-density mapping and successful ablation of a complex dual-loop atrial flutter in a patient with ccTGA and aberrant left atrial appendage. The successful procedure corroborates clinical utility of high-density mapping approach in the treatment of the patients with complex congenital heart disease accompanied by rapid arrhythmia, can be simpler, safer and more effective.

High-density Mapping of the Human Sinus Node: The Effect of Atrial Remodelling Due to Atrial Flutter

2008 ◽  
Vol 17 ◽  
pp. S121
Author(s):  
Martin Stiles ◽  
Anthony Brooks ◽  
Bobby John ◽  
Dennis Lau ◽  
Hany Dimitri ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Sinus Node ◽  
High Density ◽  
Density Mapping ◽  
Atrial Remodelling
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