scholarly journals P911Fluoroscopy integrated in 3D mapping system. Effective method of further fluoroscopy reduction during ablation of atrial fibrillation

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii180-iii180
Author(s):  
KM. Myrda ◽  
PB. Buchta ◽  
MW. Witek ◽  
AW. Wojtaszczyk ◽  
MG. Gasior
Keyword(s):  
Atrial Fibrillation ◽  
3D Mapping ◽  
Mapping System ◽  
3D Mapping System ◽  
Fluoroscopy Reduction

Abstract 16604: A Novel Endocardial Activation Analysis Software to Identify Rapid Activation Patterns During Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Raul Weiss ◽  
Ziad Zeidan ◽  
John D Hummel ◽  
Steven J Kalbfleisch ◽  
Ralph Augostini ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Leading Edge ◽  
3D Mapping ◽  
Activation Patterns ◽  
Mapping System ◽  
Basket Catheter ◽  
3D Mapping System ◽  
The Right ◽  
Computational Analyses ◽  
Rapid Activation

Introduction: The cornerstone of atrial fibrillation (AF) radiofrequency ablation (RFA) is pulmonary vein (PV) isolation. A recently described technique directs RFA to electrical rotors identified by computational analyses of 64-electrode basket catheter (BC) endocardial recordings of AF. Hypothesis: The purpose of this study was to develop and then to assess the ability of a novel analysis method, CartoFinder™ (CF), incorporated into a 3D mapping system, CARTO (Biosense Webster, CA, USA) to identify rapid activation patterns (RAP). Methods: 20 patients who were undergoing RFA AF utilizing CARTO mapping and who consented were enrolled. 1 minute BC maps of the right (RA) and left (LA) were obtained after creation of a 3D virtual anatomic shell prior to and after RFA around the PV. In each atria, 2 BC recordings were obtained at the same location, separated by 5 minutes. Results: Unipolar signals from the BC were recorded by CARTO and analyzed offline. The signal was processed to filter out far-field ventricular activity and the remaining signals were analyzed to create dynamic 3D activation maps and visually identify RAP. CF labels the leading edge of activation with a red color. Of these 20 patients, CF recordings were complete in 14 pts (mean age 59; 12 with persistent AF). There were 2.8 RAP / pt. (mean 1.3 RA; 1.6 LA). No RAP were recorded in 2 pts. The correlation of the BC separated by 5 minutes to identify the same RAP was 12/15 in RA and 15/18 in LA (total: 27/33, 82%). Conclusions: CF is a newly developed online technique to identify RAP incorporated into a conventional 3D mapping system. RAPs can be identified in the majority of patients undergoing RFA AF with approximately 80% reproducibility.

scholarly journals Catheter Ablation of Paroxysmal Atrial Fibrillation Using a 3D Mapping System

Circulation ◽  
1999 ◽  
Vol 100 (11) ◽  
pp. 1203-1208 ◽  
Author(s):  
Carlo Pappone ◽  
Giuseppe Oreto ◽  
Filippo Lamberti ◽  
Gabriele Vicedomini ◽  
Maria Luisa Loricchio ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Paroxysmal Atrial Fibrillation ◽  
3D Mapping ◽  
Mapping System ◽  
3D Mapping System

scholarly journals Successful right-sided azygos coil implantation for failed defibrillation thresholds using a 3D mapping system

2021 ◽  
Vol 30 (4) ◽  
pp. 626-628
Author(s):  
Katherine Romanowicz ◽  
Muhammad Athar ◽  
Alexandru Costea
Keyword(s):  
3D Mapping ◽  
Mapping System ◽  
3D Mapping System

scholarly journals Multi-catheter cryotherapy compared with radiofrequency ablation in long-standing persistent atrial fibrillation: a randomized clinical trial

EP Europace ◽  
2020 ◽  
Author(s):  
Mark M Gallagher ◽  
Gang Yi ◽  
Hanney Gonna ◽  
Lisa W M Leung ◽  
Idris Harding ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Persistent Atrial Fibrillation ◽  
Rf Ablation ◽  
Ablation Efficiency ◽  
Mapping System ◽  
3D Mapping System ◽  
Front Advance

Abstract Aims Restoring sinus rhythm (SR) by ablation alone is an endpoint used in radiofrequency (RF) ablation for long-standing persistent atrial fibrillation (AF) but not with cryotherapy. The simultaneous use of two cryotherapy catheters can improve ablation efficiency; we compared this with RF ablation in chronic persistent AF aiming for termination to SR by ablation alone. Methods and results Consecutive patients undergoing their first ablation for persistent AF of >6 months duration were screened. A total of 100 participants were randomized 1:1 to multi-catheter cryotherapy or RF. For cryotherapy, a 28-mm Arctic Front Advance was used in tandem with focal cryoablation catheters. Open-irrigated, non-force sensing catheters were used in the RF group with a 3D mapping system. Pulmonary vein (PV) isolation and non-PV triggers were targeted. Participants were followed up at 6 and 12 months, then yearly. Acute PVI was achieved in all cases. More patients in the multi-catheter cryotherapy group were restored to SR by ablation alone, with a shorter procedure duration. Sinus rhythm continued to the last available follow-up in 16/49 patients (33%) in the multi-catheter at 3.0 ± 1.6 years post-ablation and in 12/50 patients (24%) in the RF group at 4.0 ± 1.2 years post-ablation. The yearly rate of arrhythmia recurrence was similar. Conclusion Multi-catheter cryotherapy can restore SR by ablation alone in more cases and more quickly than RF ablation. Long-term success is difficult to achieve by either methods and is similar with both.

Abstract 16695: Rapid Activation Patterns Identified by Computational Analysis of Multielectrode Endocardial Recordings During Atrial Fibrillation in Humans

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
John D Hummel ◽  
Ziad Zeidan ◽  
Steven J Kalbfleisch ◽  
Mahmoud Houmsse ◽  
Ralph Augostini ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Computational Analysis ◽  
Pulmonary Veins ◽  
Leading Edge ◽  
Activation Patterns ◽  
Red Color ◽  
Mapping System ◽  
Basket Catheter ◽  
3D Mapping System ◽  
Rapid Activation

Introduction: Computational analysis of 64-electrode basket catheter (BC) recordings of atrial fibrillation (AF) have been used to generate visually-identified electrical rotors and focal sources that are then targeted for radiofrequency ablation (RFA). Hypothesis: The purpose of this study was to assess BC maps of right (RA) and left (LA) atria during AF in humans using a novel software, CartoFinder™ (CF) (Biosense Webster, CA, USA), which was developed to identify rapid activation patterns (RAP) and incorporate them into a 3D mapping system, CARTO. Methods: 20 patients who were undergoing RFA AF utilizing CARTO mapping and who consented were enrolled. 1 minute BC maps of the RA and LA were obtained after creation of a 3D virtual anatomic shell prior to and after RFA around the pulmonary veins (PV). There were no complications. BC maps were analyzed by CF post procedure. CF annotates the leading edge of RAP with red color (see figure). Results: Of these 20 patients, CF recordings were complete in 14 pts (mean age 59; 12 persistent AF). There were 2.8 RAP / pt. The RA RAP were located septum (n = 9), anterolateral (n=5), and posterior (n = 3) walls. The LA RAP were located anterior (n = 8), roof (n=7), and posterior (n = 7) walls. RFA was delivered on top of (n=10), within 5mm (n = 4), or distant (n=10) from any RAP. Post PV isolation, there was a 45% reduction in RAP vs pre-RFA; and, 11 pts converted to sinus (n=7) or transitioned to flutter (n=4). Conclusions: CF is a novel software algorithm incorporated into CARTO that identifies RAP in the RA and LA. RFA around the PV only results in 45% reduction of RAP, suggesting that RFA beyond traditional PV isolation is required to eliminate the bulk of RAP.

Abstract 17710: Phrenic Nerve Injury Despite High-Output Pacing in Patients Undergoing Radiofrequency Catheter Ablation of Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Brett Izzo ◽  
Miki Yokokawa ◽  
Krit Jongnarangsin ◽  
Hamid Ghanbari ◽  
Rakesh Latchamsetty ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Phrenic Nerve ◽  
Maximum Output ◽  
Radiographic Findings ◽  
Long Duration ◽  
Mapping System ◽  
3D Mapping System ◽  
Rf Energy ◽  
The Right ◽  
High Output

Introduction: High-output pacing has been advocated as a strategy to avoid injury to the phrenic nerve (PN) during antral pulmonary vein (PV) isolation. We assessed the hypothesis that pacing does not prevent PN injury in patients undergoing radiofrequency (RF) ablation of atrial fibrillation (AF). Methods: The medical records of 198 consecutive patients (age=63±12 years, 129 men, ejection fraction=57±10%, LA=44±6mm, paroxysmal=49%) undergoing their first ablation procedure for AF were reviewed. All patients underwent antral PV isolation using a 3D mapping system (CARTO XP or CARTO 3) and a 3.5 mm irrigated-tip ablation catheter (maximum power, 25 W). Prior to RF energy delivery, high-output pacing (20 mA @ 10 ms, maximum output) was performed to asses for PN capture. Sites that afforded PN capture were avoided and RF energy was delivered at adjacent sites without PN capture. The 3-D maps were reviewed to identify the prevalence and sites of PN capture. Results: High-output pacing along the anterior right antrum resulted in PN capture in 35 patients (18%). The most common site with a positive response was the crux between the upper and lower PVs (60%), followed by the right superior PV (43%), and the right inferior PV (20%). Of the patients with PN capture, 49% had only one site of capture, 20% with two sites, and 31% had 3 or more sites. All PVs were isolated at the end of the procedure. Two patients (1%) developed PN injury (symptom onset on the day after the procedure), which was confirmed on radiography. In neither case was there evidence of PN capture during the procedure. Symptoms resolved in both patients within 3 months, with normalization of radiographic findings. Conclusions: High-output pacing along the anterior right PV antrum yields PN capture in roughly one-fifth of the patients undergoing PV isolation. Despite a negative response to pacing and alteration of the lesion set, PN injury may occur. The reason for this discordance is unknown, but may include the possibility that the capture threshold of the PN exceeds the maximum output of the stimulator, or that RF energy may injure the pericardiophrenic artery, which accompanies the PN. Avoiding high-power or long-duration lesions and high contact force in this region may minimize the risk of PN injury.

Abstract 18572: Limitations of Endocardial Unipolar Voltage Mapping in Predicting the Epicardial Substrate

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yalçin Gökoglan ◽  
Mahmut F Günes ◽  
Luigi Di Biase ◽  
Carola Gianni ◽  
Sanghamitra Mohanty ◽  
...  
Keyword(s):  
Low Voltage ◽  
3D Mapping ◽  
Bipolar Voltage ◽  
Voltage Mapping ◽  
Arrhythmogenic Substrate ◽  
Mapping System ◽  
3D Mapping System ◽  
Modest Correlation

Introduction: Bipolar voltage mapping detects areas of scar and guides ablation of VT. The role of endocardial unipolar voltage mapping is not well defined. We examined the endo-epicardial substrate in a mixed cohort of patients with structural heard disease (SHD) to determine whether an endocardial unipolar low voltage area predicts the presence and location of an epicardial scar. Results: Data from 24 consecutive patients with SHD (11 ICM, 6 NICM, 3 HCM, 2 ARVC, 1 myocarditis, 1 Brugada) with a detailed (mean points per map 200) combined endocardial-epicardial substrate mapping were retrospectively reviewed. Maps were obtained using a 3D mapping system (CARTO 3) and normal thresholds used were ≤1.5 mV for bipolar voltage, and ≤5.5 (RV) or ≤8.3 mV (LV) for unipolar voltage. Mapping was performed in the LV in 17 patients, in the RV in 6 patients, in both in 1 patient. An endocardial unipolar low voltage area was found in 21/25 maps. In 12/21 maps there was no corresponding epicardial scar, while in 3/4 cases an epicardial scar was detected despite a negative unipolar map (PPV=43%, NPV=25%, P=NS; Fig. 1). In the 9 cases with both positive endocardial unipolar and epicardial bipolar maps, the epicardial scar was found in the corresponding ventricular region of the endocardial low-voltage area, although unipolar area had a tendency to overestimate the area of the scar (115 vs 95 cm 2 ). Conclusion: In this series of patients with SHD, analysis of unipolar voltage maps could not reliably predict the epicardial arrhythmogenic substrate. There is a modest correlation between areas of endocardial unipolar low voltage and epicardial scars (57% of patients with an abnormal unipolar map had a normal epicardial substrate). Moreover, an epicardial substrate cannot be safely excluded based on a normal unipolar endocardial map. Fig. 1 Abnormal bipolar epicardial map (left) with corresponding normal unipolar endocardial map (right) in a patient with ARVC. Pink dots represent area of defragmentation.

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