Koch’s triangle voltage mapping for cryoablation of slow pathway in children: preliminary data of a novel high-density technique

2021 ◽  
Author(s):  
Fabrizio Drago ◽  
Pietro Paolo Tamborrino ◽  
Luigina Porco ◽  
Marta Campisi ◽  
Veronica Fanti ◽  
...  
Keyword(s):  
Preliminary Data ◽  
High Density ◽  
Slow Pathway ◽  
Voltage Mapping

scholarly journals 703 Koch’s triangle voltage mapping for cryoablation of slow pathway in children: preliminary data of a novel high density technique

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Ilaria Cazzoli ◽  
Pietro Paolo Tamborrino ◽  
Luigina Porco ◽  
Marta Campisi ◽  
Veronica Fanti ◽  
...  
Keyword(s):  
Low Voltage ◽  
Three Dimensional ◽  
High Density ◽  
Slow Pathway ◽  
Voltage Mapping ◽  
Acute Success ◽  
Procedural Time ◽  
Conventional Mapping ◽  
Mapping Point

Abstract Aims Different authors have described three-dimensional (3D) voltage mapping of the Koch’s triangle (KT) in order to find low-voltage bridges (LVBs) as targets for a successful transcatheter ablation (TCA) of the slow pathway (SP) in children. Recently, the advisor high density (HD) Grid™ mapping catheter was introduced as new multipolar catheter for HD mapping. The aim of the study was to describe our preliminary experience with the use of HD Grid™ catheter in LVB and electrophysiologically guided cryoablation of SP in children. Methods and results Twenty-one children (mean age 13 ± 3 years) with atrioventricular nodal re-entrant tachycardia (AVNRT) underwent cryoablation of SP guided by voltage HD mapping of the KT using HD Grid™ catheter. In order to better highlight the differences with conventional mapping, point collection was performed in each patient with this new multipolar catheter and with a quadripolar catheter. The conventional mapping collected 871 ± 262 points and used 211 ± 80 points in 887 ± 275 s, whereas HD mapping collected 7468 ± 2947 points, using 604 ± 165 points in 513 ± 181 s (P < 0.001). Moreover, the LVB area mapped with HD Grid™ was about one-half smaller and clearly delineated. Cryoablation acute success rate was 100%. Overall median fluoroscopy exposure was 0.08 (0.01–5.42) µGy/m2, with a median fluoroscopy time of 0.1 (0.0–0.6) min. During the follow-up (4.8 ± 3.7 months), there were no recurrences. No complications occurred. Conclusions Our preliminary experience shows that HD mapping is faster and offers higher spatial resolution and definition. Procedural time can be reduced maintaining the TCA safe, with reduced fluoroscopy use, and successful.

scholarly journals Atrial tissue characterization by cardiac magnetic resonance and high-density mapping in patients with atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
R Adelino Recasens ◽  
L Llorca-Fenes ◽  
A Sarrias ◽  
A Teis ◽  
V Bazan ◽  
...  
Keyword(s):  
Left Atrial ◽  
Tissue Characterization ◽  
High Density ◽  
Atrial Fibrosis ◽  
Kappa Index ◽  
Bipolar Voltage ◽  
Voltage Mapping ◽  
Point Correlation ◽  
Left Atrial Fibrosis ◽  
Lge Cmr

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Left atrial fibrosis is a marker of atrial disease and it has an important role in the pathophysiology of atrial fibrillation (AF). Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is an emerging tool to detect left atrial fibrosis. However, data on the correlation between LGE-CMR detected fibrosis and low voltage areas to define fibrotic tissue is scarce. PURPOSE To assess the correlation and degree of concordance between LGE-CMR and high-density bipolar voltage mapping for the identification of left atrial abnormal tissue. METHODS Seven patients scheduled for AF ablation (including first and redo procedures) underwent a preprocedural 1.5 Tesla LGE-CMR including left atrial 3D inversion-recovery steady-state free precession sequence (ECG and respiratory triggering) 20 minutes after the injection of 0.2 mmol/kg of gadobutrol. A high-density electroanatomical voltage mapping was acquired with a 16-electrode grid configuration mapping catheter during sinus rhythm. LGE-CMR studies were analyzed off-line with an advanced image post-processing tool (ADAS 3D). Atrial wall intensity was normalized to blood pool, obtaining an image intensity ratio (IIR) value for each CMR point of the 3D model.  High-density bipolar voltage maps and LGE-CMR 3D left atrial reconstruction were merged (figure, panel A). Voltage points were projected to the LGE-CMR left atrial 3D model, allowing point-by-point correlation analysis between voltage (log transformed due to non-normal distribution) with IIR. Left atrial fibrosis area and percentage were quantified using the standard cut-off values (bipolar voltage <0.5mV and IIR >1.2). We assessed the degree of concordance for normal and abnormal (fibrosis) tissue classification between the two techniques using different cut-off values (< 0.5mV and <1mV for bipolar voltage and >0.9, >1, >1.1 and >1.2 for IIR).   RESULTS The average fibrosis area detected with LGE-CMR was lower than that detected with high-density bipolar voltage, using standard cut-off values (18.6 ± 5.7 cm2 vs. 40.6 ± 12.5 cm2, p = 0.13 respectively). There was a poor global point-by-point correlation between log-transformed voltage and IIR was r=-0.093, p < 0.001 (figure, panel B). The best concordance was obtained when using bipolar voltage and IIR of 0.5mV and 1.2, respectively (64.7 %; Kappa 0.101). However, the highest kappa index (0.142) for concordance was achieved with cutoff values of bipolar voltage <1mV and IIR >1, with an agreement percentage of 54.6%. CONCLUSIONS Left atrial tissue characterization between LGE-CMR and high-density bipolar voltage mapping showed significant but poor point-by-point correlation. Although the highest concordance was obtained using standard cutoff values, the Kappa index was best when applying non-standard cutoffs (1mV for bipolar voltage and >1 for IIR). Abstract Figure.

Lithography Process Optimization for 3D and 2.5D Applications

2013 ◽  
Vol 2013 (1) ◽  
pp. 000790-000793 ◽  
Author(s):  
Doug Shelton ◽  
Tomii Kume
Keyword(s):  
High Resolution ◽  
Process Optimization ◽  
Preliminary Data ◽  
Mass Production ◽  
Low Cost ◽  
High Density ◽  
Through Silicon Via ◽  
Key Technology ◽  
Lithography Process ◽  
Advanced Packaging

Lithography process optimization is a key technology enabling mass production of high-density interconnects using 3D and 2.5D technologies. In this paper, Canon continues its investigation of lithography optimization of thick-resist profiles and overlay accuracy to increase process margins for Through-Silicon Via (TSV) and Redistribution Layer (RDL) applications. Canon will also provide updates on the FPA-5510iV and FPA-5510iZ i-line steppers that are gaining acceptance as high-resolution, and low-cost lithography solutions for aggressive advanced packaging, 3D and 2.5D applications also preliminary data illustrating 450 mm wafer process challenges.

Catheter Ablation of Low-Voltage Areas for Persistent Atrial Fibrillation: Procedural Outcomes Using High-Density Voltage Mapping

2020 ◽  
Vol 36 (12) ◽  
pp. 1956-1964 ◽  
Author(s):  
Pablo B. Nery ◽  
Wael Alqarawi ◽  
Girish M. Nair ◽  
Mouhannad M. Sadek ◽  
Calum J. Redpath ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Low Voltage ◽  
Persistent Atrial Fibrillation ◽  
High Density ◽  
Voltage Mapping ◽  
Procedural Outcomes

Quantitative assessment of left atrial scar using high-density voltage mapping and a novel automated voltage analysis tool

2019 ◽  
Vol 59 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Szilvia Herczeg ◽  
Katie Walsh ◽  
John J Keaney ◽  
Edward Keelan ◽  
John Travers ◽  
...  
Keyword(s):  
Left Atrial ◽  
Quantitative Assessment ◽  
High Density ◽  
Analysis Tool ◽  
Voltage Mapping

P839Long-term follow-up after atrial fibrillation ablation using 3D high-density voltage mapping with a single-puncture approach

EP Europace ◽  
2018 ◽  
Vol 20 (suppl_1) ◽  
pp. i155-i155
Author(s):  
M M Oliveira ◽  
P S Cunha ◽  
B Valente ◽  
N Silva ◽  
G Portugal ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Density ◽  
Atrial Fibrillation Ablation ◽  
Voltage Mapping

High-density bipolar voltage mapping for substrate-guided ablation of atrial fibrillation

2018 ◽  
pp. 1115-1115
Author(s):  
Maciej Wójcik ◽  
Łukasz Konarski ◽  
Robert Błaszczyk ◽  
Piotr Aljabali ◽  
Przemysław Zając
Keyword(s):  
Atrial Fibrillation ◽  
High Density ◽  
Bipolar Voltage ◽  
Voltage Mapping

scholarly journals Comparison of Unipolar and Bipolar Voltage Mapping for Localization of Left Atrial Arrhythmogenic Substrate in Patients With Atrial Fibrillation

2020 ◽  
Vol 11 ◽  
Author(s):  
Deborah Nairn ◽  
Heiko Lehrmann ◽  
Björn Müller-Edenborn ◽  
Steffen Schuler ◽  
Thomas Arentz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Low Voltage ◽  
High Density ◽  
Border Zone ◽  
Electrode Spacing ◽  
Bipolar Voltage ◽  
Voltage Mapping ◽  
Arrhythmogenic Substrate ◽  
The Impact

Background: Presence of left atrial low voltage substrate in bipolar voltage mapping is associated with increased arrhythmia recurrences following pulmonary vein isolation for atrial fibrillation (AF). Besides local myocardial fibrosis, bipolar voltage amplitudes may be influenced by inter-electrode spacing and bipole-to-wavefront-angle. It is unclear to what extent these impact low voltage areas (LVA) in the clinical setting. Alternatively, unipolar electrogram voltage is not affected by these factors but requires advanced filtering.Objectives: To assess the relationship between bipolar and unipolar voltage mapping in sinus rhythm (SR) and AF and identify if the electrogram recording mode affects the quantification and localization of LVA.Methods: Patients (n = 28, 66±7 years, 46% male, 82% persistent AF, 32% redo-procedures) underwent high-density (>1,200 sites, 20 ± 10 sites/cm2, using a 20-pole 2-6-2 mm-spaced Lasso) voltage mapping in SR and AF. Bipolar LVA were defined using four different thresholds described in literature: <0.5 and <1 mV in SR, <0.35 and <0.5 mV in AF. The optimal unipolar voltage threshold resulting in the highest agreement in both unipolar and bipolar mapping modes was determined. The impact of the inter-electrode distance (2 vs. 6 mm) on the correlation was assessed. Regional analysis was performed using an 11-segment left atrial model.Results: Patients had relevant bipolar LVA (23 ± 23 cm2 at <0.5 mV in SR and 42 ± 26 cm2 at <0.5 mV in AF). 90 ± 5% (in SR) and 85 ± 5% (AF) of mapped sites were concordantly classified as high or low voltage in both mapping modes. Discordant mapping sites located to the border zone of LVA. Bipolar voltage mapping using 2 vs. 6 mm inter-electrode distances increased the portion of matched mapping points by 4%. The unipolar thresholds (y) which resulted in a high spatial concordance can be calculated from the bipolar threshold (x) using following linear equations: y = 1.06x + 0.26mV (r = 0.994) for SR and y = 1.22x + 0.12mV (r = 0.998) for AF.Conclusion: Bipolar and unipolar voltage maps are highly correlated, in SR and AF. While bipole orientation and inter-electrode spacing are theoretical confounders, their impact is unlikely to be of clinical importance for localization of LVA, when mapping is performed at high density with a 20-polar Lasso catheter.

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