Economic evaluation of an ultra-high density mapping system compared to non-ultra-high density mapping systems for radiofrequency catheter ablation procedures in patients with atrial fibrillation

Abstract Introduction Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) and is generally associated with a significant deterioration of clinical status. Non-pharmacological treatment such as surgical and catheter ablation has become an established therapy for symptomatic AF but in patients with HCM often having a chronically increased left atrial pressure and extensive atrial cardiomyopathy the long-term outcome is uncertain. Purpose The present study aimed to analyse the long-term outcome of AF ablation in HCM and the mechanism of recurrent atrial arrhythmias using high-density mapping systems. Methods A total of 65 patients (age 64.5±9.9 years, 42 (64.6%) male) with HCM undergoing AF ablation for symptomatic AF were included in our study. The ablation strategy for catheter ablation included pulmonary vein isolation in all patients and biatrial ablation of complex fractionated electrograms with additional ablation lines if appropriate. In patients with suspected atrial tachycardia (AT) high-density activation and substrate mapping were performed. A surgical ablation at the time of an operative myectomy for left ventricular outflow tract obstruction was performed in 8 (12.3%) patients. The outcome was analysed using clinical assessment, Holter ECG and continuous rhythm monitoring of cardiac implantable electric devices. Results Paroxysmal AF was present in 27 (41.6%), persistent AF in 37 (56.9%) and primary AT in 1 (1.5%) patients. The mean left atrial diameter was 54.1±12.5 ml. In 11 (16.9%) patients with AT high-density mapping was used to characterize the mechanism of the ongoing tachycardia. After 1.9±1.2 ablation procedures and a follow-up of 48.5±37.2 months, ablation success was demonstrated in 58.9% of patients. The success rate for paroxysmal and persistent AF was 70.0% and 55.8%, respectively (p=0.023). Of those patients with AT high-density mapping guided ablation was successful in 44.4% of patients. The LA diameter of patients with a successful ablation was smaller (52.2 vs. 58.1 mm; p=0.003). Conclusion Non-pharmacological treatment of AF in HCM is effective during long-term follow-up. Paroxysmal AF and a smaller LA diameter are favourable for successful ablation. In patients with complex AT the use of high-density mapping can guide ablation resulting in further ablation success in a reasonable number of patients.

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Atrial tachycardias: focal and multifocal atrial tachycardias

ESC CardioMed ◽

10.1093/med/9780198784906.003.0484 ◽

2018 ◽

pp. 2070-2075

Author(s):

Pierre Jaïs ◽

Nicolas Derval

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Atrial Tachycardia ◽

New Technologies ◽

Atrial Fibrillation Ablation ◽

Practical Approach ◽

Density Mapping ◽

Non Invasive ◽

Mapping System ◽

Surface Electrocardiogram

Atrial tachycardia (AT) is increasingly observed in patients, particularly in the context of atrial fibrillation ablation. The exact electrophysiological mechanisms are not easy to establish but a practical approach consists in distinguishing macroreentries from focal ATs as this is crucial for the ablation strategy. In centrifugal arrhythmias (such as focal AT and localized reentry), the activation originates from a source and spreads centrifugally to the rest of the atria, while in macroreentries, it follows a large path around a central obstacle and reenters. The analysis of the surface electrocardiogram is of limited value to predict the macroreentrant or focal nature of the arrhythmia. Antiarrhythmic drugs are usually tried first and in case of failure, catheter ablation is considered, with or without the support of a localization/mapping system. The most challenging cases are those with multifocal AT as they are poorly responsive to drugs, difficult to ablate, and arise in patients in poor medical conditions. New technologies such as high-density mapping and non-invasive mapping may facilitate the identification of mechanisms and target(s) for catheter ablation.

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Catheter ablation of paroxysmal atrial fibrillation using high-density mapping-guided substrate modification

Pacing and Clinical Electrophysiology ◽

10.1111/pace.13524 ◽

2018 ◽

Vol 41 (12) ◽

pp. 1630-1634

Author(s):

Wei Zhou ◽

Long Wang ◽

Bo Zhou ◽

Lirong Wu

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Paroxysmal Atrial Fibrillation ◽

High Density ◽

Density Mapping ◽

Substrate Modification

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High Density 3D Mapping and Ablation of Complex Cardiac Arrhythmias: Our Experience in NICVD

Bangladesh Heart Journal ◽

10.3329/bhj.v36i2.56035 ◽

2021 ◽

Vol 36 (2) ◽

pp. 98-104

Author(s):

Md Mohsin Hossain ◽

Md Mustafizur Rahman ◽

Asif Zaman Tushar ◽

Al Mamun ◽

Md Nazmul Haq ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ventricular Tachycardia ◽

Radiofrequency Ablation ◽

Catheter Ablation ◽

Cardiac Arrhythmias ◽

High Density ◽

3D Mapping ◽

Mapping System ◽

Acute Success ◽

The Mean

Background: Catheter ablation can be curative in patients with drug-refractory tachyarrhythmias. 3D electro anatomical mapping (EAM) is an established tool facilitating catheter ablation. This system is particularly valuable for mapping complex arrhythmias, which provide excellent assistance to catheter navigation, reduces fluoroscopy exposure, and also allow for the accurate placement of catheters. The Rhythmia Mapping System (RMS, Boston Scientific) is a novel system that allows for ultra-fast, high-density 3D mapping. Aim of this Study: The aim of this study was to find out the result of a high-density 3D mapping for the ablation of complex Cardiac Arrhythmias and to share our experiences. Methods: A total number of 44 patients of different tachyarrhythmias were scheduled for catheter ablation by Rhythmia Mapping System in National Institute of Cardiovascular Diseases, Bangladesh from 3rd February’2018 to 18th July’2019. During and after, the procedure all the cases were evaluated for different procedure parameters, acute success and in-hospital success. Results: Among the patients (28/44 male) 13 (25.55%) cases were atrial fibrillation, 6 (16.64%) cases were atrial flutter, 6 (16.64%) cases were atrial tachycardia, 2 (4.55%) cases were ventricular tachycardia, 11 (25%) cases were PVC and 6 (16.64%) cases were accessory pathway. The mean age was 38±4.5 years. In 25 (56.82%) of tachyarrhythmia patients, the mechanism was macro reentry/micro reentry, while in 19 (43.18%) cases the mechanism was increased automaticity. In all cases, the tachycardias were adequately mapped & proper identification of focus was done during the index procedure with the ultra-high density 3-D Rhythmia Mapping System (RMS). These all were successfully terminated by radiofrequency ablation, except one, which was one of the two cases of Ventricular tachycardia. With this system our study samples had a success rate of 98% with arrhythmia elimination. In patients of atrial fibrillation, all 4 pulmonary veins isolation were done. The mean mapping time was 28.6 ± 17 minutes, and the mean radiofrequency ablation time to arrhythmia termination was 3.2± 2.6 minutes. During our study only two out of 44 patients developed complications. One of the patients with atrial fibrillation developed cardiac tamponade and the other patient with PVC originating from Aortic cusp developed ischemic stroke. Fortunately, they were both managed accordingly. During hospital discharge, all the patients were free of tachyarrhythmia and were in sinus rhythm. Conclusions: This new automated ultrahigh-resolution mapping system allows accurate diagnosis of tachyarrhythmia circuits. Ablation of the focus resulted in high acute success. Bangladesh Heart Journal 2021; 36(2): 98-104

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