scholarly journals High density mapping guided partial antral ablation for a pulmonary vein isolation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jongmin Hwang ◽  
Seongwook Han ◽  
Chun Hwang ◽  
Hyoung-Seob Park ◽  
Cheol Hyun Lee ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Left Atrial ◽  
High Density ◽  
Atrial Tachyarrhythmia ◽  
Activation Pattern ◽  
Activation Patterns ◽  
Density Mapping ◽  
Mapping System ◽  
Segment Pattern ◽  
Activation Mapping

AbstractThe muscular discontinuities at the pulmonary vein (PV)–left atrial (LA) junction are known. The high-density mapping may help to find the muscular discontinuity. This study evaluated the efficacy of a partial antral ablation for a pulmonary vein (PV) isolation using high density (HD) mapping. A total of 60 drug-refractory atrial fibrillation (AF) patients undergoing catheter ablation were enrolled. The detailed activation mapping of each PV and LA junction was performed using an HD mapping system, and each PV segment’s activation pattern was classified into a “directly-activated from the LA” or “passively-activated from an adjacent PV segment” pattern. The antral ablations were performed at the directly-activated PV segments only when the PV had “passively-activated segments”. If the PV did not contain passively-activated segments, a circumferential antral ablation was performed on those PVs. A “successful partial antral ablation” was designated if the electrical isolation of targeted PV was achieved by ablation at the directly-activated segments only. If the isolation was not achieved even though all directly-activated segments were ablated, a “failed partial antral ablation” was designated, and then a circumferential ablation was performed. Among 240 PVs, passively-activated segments were observed in 140 (58.3%) PVs. Both inferior PVs had more passively-activated segments than superior PVs, and the posteroinferior segments had the highest proportion of passive activation. The overall rate of successful partial antral ablation was 85%. The atrial tachyarrhythmia recurrence was observed in 10 patients (16.7%) at 1-year. HD mapping allowed the evaluation of the detailed activation patterns of the PVs, and passively-activated segments may represent muscular discontinuity. Partial antral ablation of directly-activated antral segments only was feasible and effective for a PVI.

scholarly journals 16-22: Quantification of the ablation zone after wide area circumferential pulmonary vein isolation applying a new high-density mapping system

EP Europace ◽  
2016 ◽  
Vol 18 (suppl_1) ◽  
pp. i6-i6
Author(s):  
Francesco Santoro ◽  
Ardan Saguner ◽  
Christine Lemes ◽  
Christian Sohns ◽  
Shibu Mathew ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
High Density ◽  
Wide Area ◽  
Ablation Zone ◽  
Density Mapping ◽  
Mapping System ◽  
Circumferential Pulmonary Vein Isolation

scholarly journals Microreentrant left atrial tachycardia circuit mapped with an ultra-high-density mapping system

2017 ◽  
Vol 3 (4) ◽  
pp. 224-228 ◽  
Author(s):  
Fu Siong Ng ◽  
Fernando Guerrero ◽  
Vishal Luther ◽  
Markus Sikkel ◽  
Phang Boon Lim
Keyword(s):  
Left Atrial ◽  
Atrial Tachycardia ◽  
High Density ◽  
Density Mapping ◽  
Mapping System

Ultra-high-density mapping of left atrial and pulmonary vein macroreentry using double conduction gaps

2018 ◽  
Vol 29 (4) ◽  
pp. 630-631
Author(s):  
Michitsugu Komeda ◽  
Yosuke Miwa ◽  
Akiko Ueda ◽  
Kyoko Soejima
Keyword(s):  
Pulmonary Vein ◽  
Left Atrial ◽  
High Density ◽  
Density Mapping

scholarly journals Presence of low voltage area predicts atrial tachyarrhythmia inducibility with atrial burst pacing after pulmonary vein isolation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Kawai ◽  
K Nagaoka ◽  
S Takase ◽  
K Sakamoto ◽  
H Ikuta ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Low Voltage ◽  
Past History ◽  
Univariate Analysis ◽  
Atrial Tachyarrhythmia ◽  
Chads2 Score ◽  
Atrial Capture ◽  
History Of

Abstract Background Induction of atrial fibrillation (AF)/atrial tachycardia (AT) by atrial burst pacing following ablation procedure may reflect the presence of residual substrates in the atria that maintain AF. However, the relation between the inducibility and left atrial low voltage area (LVA) has not been established. Methods Fifty-nine patients (65 years old, 43 males) with persistent AF who underwent pulmonary vein isolation (PVI)-based ablation were studied. All patients underwent left atrial voltage mapping during sinus rhythm and atrial burst pacing after PVI. Atrial burst pacing was performed with 30-beat at an amplitude of 10V from the ostium of the coronary sinus; increasing from 240 to 320 ppm in steps of 20 ppm or failure to 1:1 atrial capture. Inducibility was defined as AF/AT lasting more than 5 minutes following burst pacing. Left atrial LVA and other co-variates were analyzed with regard to burst pacing positivity. Results AF/AT was induced by burst pacing in 23 patients (39%). Univariate analysis revealed that past history of stroke, CHADS2 score and presence of left atrial LVA were significantly associated with the inducibility of AF/AT. Multivariate analysis revealed that only the presence of LVA was associated with the inducibility (OR 1.5: per 10% increase; p=0.04). We focused on the relationship between the extent of LVA and burst positivity. AF/AT inducibility increased as low voltage area increased, and it was as high as 72.7% when low voltage area was more than 20% (P<0.05). Interestingly, induced arrhythmia type was AT rather than AF when low voltage area was more than 20%. Conclusions Presence of left atrial LVA is an independent predictor of atrial tachyarrhythmia inducibility after PVI in patients with persistent AF. A large amount of low voltage area is related to AT inducibility rather than AF. Extent of LVA and burst positivity Funding Acknowledgement Type of funding source: None

P957Characteristics of atrial tachycardia after mitral surgey via biatrial trans-septal approach using high density mapping system

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Cataldi ◽  
M Andronache ◽  
R Eschalier ◽  
F Jean ◽  
R Bosle ◽  
...  
Keyword(s):  
Atrial Tachycardia ◽  
Sinus Node ◽  
Pulmonary Veins ◽  
High Density ◽  
Congenital Defects ◽  
Density Mapping ◽  
Mapping System ◽  
Oblique Incision ◽  
Pace Maker ◽  
The Right

Abstract Background The biatrial trans-septal approach (BTSa) ameliorates mitral valve (MV) exposure in difficult cases when routine left atriotomy doesnt"t allow it. Main steps are an oblique incision on the right atrium (RA), reaching medially the right pulmonary veins (PV), a septal incision from the fossa ovalis, extended up to reach the first incision, then on the left atrium (LA). Purpose We aim to study the arrhythmic burden in this post-surgical context, focusing on atrial tachycardia (AT), to investigate the complexity of several possible circuits. Methods All patients (>18yo) with previous MV surgery via BTSa for MV repair or replacement, who underwent ablation of AT from January 2017 to September 2019, were enrolled. Patients ablated for persistent or paroxysmal AF, or with AF during the index procedure were excluded. Patients with associated surgery on other valves or congenital defects, coronary, surgical or percutaneous rhythm interventions weren’t excluded. Electroanatomical mapping was created using 2 different high-density mapping system. Substrate and activation map and radio-frequency (RF) ablation (25-50W, Ablation Index target 400) were realized. Cartographies were analysed to evaluate AT re-entry circuit, critical isthmus (CI) location and characterization, atrial vulnerability. Procedural outcomes (AT termination, sinus rhythm (SR) restoration, anti-arrhythmic drugs (AAD) withdrawal), and peri-procedural complications were also evaluated. Results We enrolled 49 patients (median age 57 ± 15), finding a maximum of 5 AT per procedure (2 ± 1). A total of 112 AT were mapped: the majority (72%) were persistent AT, 8,2% common atrial flutter. Cycle length was 314 ± 74 msec, with proximal-distal activation of coronary sinus (78%). A multiple re-entry circuit was observed in 70% of index AT. We identified 152 critical isthmus (maximum 5 per procedure). Only 27,9% of our patients had a single CI; CTI was the most frequent one (n = 37), envolved in 33% of all AT, while BTS scars altogether were envolved in 65% AT. A complete AT circuit was mapped in the RA, the LA and both atria in respectively 49%, 11,5% and 39%AT. The distribution of CIs is shown in figure 1. Biatrial and left AT leads to superior procedure, RF and fluoroscopy duration (p <0,05). SR was restored in 93,4%of patients, requiring a DC shock in 4 cases. Immediate AAD withdrawal was achieved after 41%procedures. No pericardial, oesophageal, vascular or phrenic complication occurred. 4 pace-maker implantations were realized because of 3 interatrial, 2 AV block and a sinus node dysfunction. Conclusions AT occurring after a BTSa have a high prevalence of multiple re-entry circuits with multiple critical isthmus. Ablation in this context is feasible and safe but often requires a left atrial access. Mapping of both atria should be considered to identify critical isthmus and tailored ablation strategy. Abstract Figure 1. Critical Isthmus Distribution

Ultra‐rapid high‐density mapping system with the phase singularity technique is feasible in identifying rotors and focal sources and predicting AF termination

2019 ◽  
Vol 30 (6) ◽  
pp. 952-963 ◽  
Author(s):  
Jennifer Jeanne B. Vicera ◽  
Li‐Wei Lo ◽  
Yamada Shinya ◽  
Yu‐Hui Chou ◽  
Yenn‐Jiang Lin ◽  
...  
Keyword(s):  
High Density ◽  
Phase Singularity ◽  
Density Mapping ◽  
Mapping System

P3778Long-term outcome of non-pharmacologial treatment of atrial fibrillation in hypertrophic cardiomyopathy: a large single-centre experience

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Dinshaw ◽  
M Lemoine ◽  
J Hartmann ◽  
B Schaeffer ◽  
N Klatt ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
High Density ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Density Mapping ◽  
Ablation Success

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.

scholarly journals Micro-reentry right atrial tachycardia originating from fossa ovalis: a case report of high-density mapping by PentaRay catheter

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Jin-Yi Li ◽  
Xiang-Wei Lv ◽  
Guo-Qiang Zhong ◽  
Hong-Hong Ke
Keyword(s):  
Atrial Tachycardia ◽  
Mapping Method ◽  
High Density ◽  
Right Atrial ◽  
Ablation Therapy ◽  
Density Mapping ◽  
Mapping System ◽  
Conventional Mapping ◽  
Electrophysiological Examination

Abstract Background Micro-reentry tachycardia usually emerges in scar tissues related to post-atrial fibrillation ablation and cardiomyopathy. It is difficult to identify the micro-reentry circuit accurately by conventional mapping method. Case summary A 74-year-old man presented with paroxysmal atrial tachycardia (AT) presenting as palpitations. He was evaluated by an electrophysiological examination using a high-density CARTO mapping system. The mapping results showed the AT with a cycle length of 184 ms was focused on his right atrial fossa ovalis (FO). In this small area, the high-density mapping demonstrated a significant micro-reentrant tachycardia. Radiofrequency ablation at the centre of the micro-reentrant circuit successfully terminated the AT. No recurrences were observed during a 12-month follow-up. Discussion This case demonstrated a micro-reentrant AT originates from the FO without cardiomyopathy or previous ablation with specific loops. This is an unusual location for AT though and can cause difficulty for operators if it terminates or is non-sustained. High-density mapping using a PentaRay catheter can effectively characterize micro-reentrant circuits and determine the real target for ablation therapy.

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