COMPARISON OF CIRCUMFERENTIAL PULMONARY VEIN ANATOMY MAPPING IN PATIENTS WITH ATRIAL FIBRILLATION GUIDED BY CARTO MAPPING SYSTEM AND HIGH-DENSITY MESH MAPPING CATHETER

Abstract Introduction It is reported that for patients with non-paroxysmal (persistent or long-standing persistent) atrial fibrillation (Non-PAF), extended ablation to atrial walls in addition to pulmonary vein isolation (PVI) did not improve the long-term outcome. On the other hand, modulation of Non-PAF drivers (or perpetuators) has been proposed as one of the alternative effective ablation strategies for Non-PAF. Purpose To clarify whether the rotor ablation under online real-time high-density phase mapping system is effective for PVI-refractory Non-PAF ablation. Methods Under such circumstances, our academic group had recently developed the online real-time high-density phase mapping system (ExTRa Mapping™) by industrial alliance. The phase map moving images were based on 41 intra-atrial bipolar signals recorded by a 20-pole spiral-shaped catheter (2.5 cm in diameter) and on in silicorapid prediction of spatio-temporal atrial excitations (artificial intelligence system). Then we applied the ExTRa Mapping to clinical practice in order to directly visualize rotors in patients with Non-PAF, and investigated the middle- to long-term outcome of the ExTRa Mapping-guided rotor ablation (ExTRa-ABL). Results Thirty-eight patients (63±8 y/o, 30 males) with Non-PAF demonstrating refractoriness to PVI were enrolled in this study. Ablation for cavo-tricuspid isthmus and/or superior vena cava isolation was additionally performed at physicians' discretion. After these procedures, the ExTRa-ABL was performed in order to modify Non-PAF substrates, causing rotor control. The modification of the rotors was evaluated by re-mapping with the use of the ExTRa Mapping at the end of each ablation session. Patients were followed at 1, 3, 6 months and every year after the procedure. All of them were followed for 21±8 months. During the follow-up period, Non-PAF was recurred in only 8 of 38 (21%). Furthermore, we found if PVI-refractory Non-PAF duration was shorter than 6 years, the non-recurrence rate remained ≥80% (see Figure), which was markedly better outcome comparing with previous reports with regard to Non-PAF ablation. Figure 1 Conclusion Comparing with conventional Non-PAF ablation strategies, our novel approach with the use of the online real-time high-density phase mapping system might improve medium- to long-term outcome of PVI-refractory Non-PAF treatment.

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Comparison of circumferential pulmonary vein anatomy mapping guided by 3D mapping versus a mesh mapping catheter

Chronic Diseases and Translational Medicine ◽

10.1016/j.cdtm.2015.02.012 ◽

2015 ◽

Vol 1 (2) ◽

pp. 89-95

Author(s):

Yi-Wen Yan ◽

Gang Chen ◽

Feng Zhang ◽

Song-Wen Chen ◽

Wei-Dong Meng ◽

...

Keyword(s):

Pulmonary Vein ◽

3D Mapping ◽

Mapping Versus ◽

Mesh Mapping ◽

Mapping Catheter ◽

Pulmonary Vein Anatomy

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Persistent atrial fibrillation originating from prominent Eustachian ridge: Precise identification of non-pulmonary vein foci using a high-density grid mapping catheter

HeartRhythm Case Reports ◽

10.1016/j.hrcr.2021.03.008 ◽

2021 ◽

Author(s):

Yasuteru Yamauchi ◽

Rena Nakamura ◽

Takatoshi Shigeta ◽

Yuichiro Sagawa ◽

Kaoru Okishige ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Persistent Atrial Fibrillation ◽

High Density ◽

Precise Identification ◽

Grid Mapping ◽

Mapping Catheter

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P1028Incidence and location of residual gaps identified by a high-density grid-style mapping catheter after PVI is confirmed by pacing the ablation lines

EP Europace ◽

10.1093/europace/euaa162.074 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

M Giuggia ◽

M Volpicelli ◽

N Bottoni ◽

P Gora ◽

M Mantica

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

De Novo ◽

Clinical Success ◽

The United States ◽

Small Sample ◽

High Density ◽

Ablation Line ◽

Mapping Catheter

Abstract Background Durable pulmonary vein isolation (PVI) is critical to the clinical success of ablation for treatment of atrial fibrillation (AF). Pacing along the ablation line (often using the ablation catheter), is one technique that is commonly used for confirmation of PVI. While this technique is common in practice, it has not been systematically evaluated against other methods for confirming PVI. A high-density grid-style mapping catheter (HD Grid) enabling simultaneous recording of adjacent bipolar EGMs in two directions (HD Wave) is now available in multiple geographies. The sensitivity of this technology for periprocedural identification of gaps in PVI lines has not previously been compared to the technique of pacing the ablation lines. Purpose To assess the utility of a high-density grid-style catheter for confirming PVI, and to evaluate sensitivity for identification of gaps relative to a technique of pacing the ablation lines. Methods Self-reported procedural data was prospectively collected in atrial fibrillation ablation procedures. Cases in which pulmonary vein isolation was confirmed by pacing the ablation line and subsequently assessed with HD Grid were selected for analysis. Techniques for PVI confirmation were analyzed and the incidence and location of residual gaps following PVI confirmation via pacing was quantified. Results A total of 22 AF ablation procedures (age 60.1 ± 9.0 years, LVEF 59.3 ± 5.7%, CHADS 1.5 ± 1.4, hypertension 45.5%) across 5 centers in Italy and the United States were analyzed. De novo and repeat ablations represented 72.7% and 22.7% of cases, respectively (4.5% not reported). PVI was confirmed by pacing along the ablation line with an average output of 8.8 ± 1.9mV and pulse width of 2.2 ± 0.7ms (10mv at 2ms utilized in 59.1%). Subsequent PVI assessment was performed with HD Grid using the HD Wave configuration in all cases. PVI confirmation techniques included exit block confirmation (90.9%), voltage mapping (59.1%), loss of pace capture along ablation lines (40.9%), entrance block confirmation (18.2%), and activation mapping (4.5%); note: total exceeds 100% as more than one technique may be employed in a single case. The HD Grid identified a total of 30 gaps in 15 (68.2%) patients, which were initially missed by pacing along the ablation lines. No adenosine or isoproterenol use was documented in any case. Conclusion(s): Use of the HD Grid appears to increase substantially, the sensitivity for identifying gaps in PVI lesion sets relative to a technique of pacing the ablation line. Limitations of this analysis include small sample size and workflows which consistently assessed PVI with the HD grid following confirmation of isolation by pacing the ablation lines. Despite these limitations, the high prevalence of residual gaps is quite provocative and may warrant additional study. Abstract Figure.

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P1061Incidence and location of PVI gaps identified post-cryoballoon ablation for atrial fibrillation

EP Europace ◽

10.1093/europace/euaa162.073 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

Z Eldadah ◽

C Jons ◽

Z Hollis ◽

L Dekker ◽

S Mathew ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Single Case ◽

The United States ◽

Small Sample ◽

High Density ◽

Cryoballoon Ablation ◽

Density Mapping ◽

Diagnostic Catheter ◽

Mapping Catheter

Abstract Background Successful delivery of continuous and durable pulmonary vein isolation (PVI) lesion sets is recognized as being critical to long-term clinical outcomes following ablation for atrial fibrillation (AF). Confirmation of PVI following cryoballoon ablation is commonly achieved using a 3.3F circular mapping catheter (CMC) which can be delivered through the central lumen of the cryoballoon, but other diagnostic tools may be used alone or in conjunction with the 3.3F CMC. A high-density, grid-style mapping catheter is now available in multiple geographies; use in cryoballoon ablation procedures and associated outcomes has not been previously reported. Purpose To evaluate diagnostic catheter usage patterns in cryoablation procedures and identify associated trends in procedural characteristics and acute outcomes. Methods Self-reported procedural data was prospectively collected in AF cryoablation cases utilizing various diagnostic catheter tools, including the 3.3F CMC and high-density, grid-style mapping catheter (HD Grid). Procedural characteristics and acute outcomes, including the incidence and location of gaps post-ablation, were recorded and analyzed. Results Data was collected in 23 cryoablation procedures performed in 7 centers across the United States and Europe. De novo and repeat ablations represented 65.2% and 21.7% of cases, respectively (13.0% not reported). 3D mapping was employed in 95.7% of cases. A left common pulmonary vein was present and ablated in 8.7% (2/23). The 28mm cryoballoon was utilized in all cases, with a single case using both a 23mm and 28mm cryoballoon. The 3.3F CMC was used to confirm isolation in all cases using a variety of techniques: voltage mapping (60.9%), exit block (56.5%), entrance block (30.4%), propagation mapping (4.3%), and activation mapping (4.3%); note: total exceeds 100% as more than one technique may be employed in a single case. In 18 cases, PVI was confirmed using a 3.3F CMC followed by secondary confirmation with HD Grid, enabling a direct comparison of the two technologies. The HD Grid identified a total of 12 gaps in 4 (22.2%) patients, which were missed by the 3.3F CMC (Figure 1). No adenosine or isoproterenol use was documented in any case. Conclusion(s): The 3.3F CMC is routinely used to confirm PVI following cryoballoon ablation for atrial fibrillation, but it may fail to identify gaps in some patients. Subsequent assessment of PVI using the HD Grid identified residual gaps in nearly a quarter of patients, suggesting that sensitivity for gap detection may be improved with this tool. Limitations of this analysis include the small sample size and workflows which consistently assessed PVI with the high-density mapping catheter after confirming isolation with the 3.3F CMC. Despite these limitations, the incidence of residual gaps observed is noteworthy and may warrant additional study. Abstract Figure.

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Catheter Ablation of Atrial Fibrillation: Three-dimensional Transesophageal Echocardiography Provides an Excellent Overview over the Pulmonary Vein Anatomy Facilitating Radiofrequency and Cryoablation Procedures

Cardiology and Angiology An International Journal ◽

10.9734/ca/2017/34273 ◽

2017 ◽

Vol 6 (2) ◽

pp. 1-18 ◽

Cited By ~ 1

Author(s):

Klaus Kettering ◽

Felix Gramley ◽

Stephan Bardeleben

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Transesophageal Echocardiography ◽

Pulmonary Vein ◽

Three Dimensional ◽

Pulmonary Vein Anatomy

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Circular mapping catheter entrapment in mitral valve apparatus requiring emergency surgery: a rarely reported complication of pulmonary vein isolation procedure for atrial fibrillation

BMJ Case Reports ◽

10.1136/bcr-2017-221338 ◽

2017 ◽

pp. bcr-2017-221338 ◽

Cited By ~ 1

Author(s):

Muhammad Iftikhar Sabar ◽

Abhay Bajpai ◽

Aziz Momin ◽

Riyaz A. Kaba

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Emergency Surgery ◽

Isolation Procedure ◽

Mapping Catheter

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Abstract 16807: Role of Rotor Activation Within the Pulmonary Vein as the Driving Sources for Atrial Fibrillation: Three-dimensional Analysis using a Non-contact Mapping System

Circulation ◽

10.1161/circ.132.suppl_3.16807 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Hiroshige Yamabe ◽

Hisanori Kanazawa ◽

Tadashi Hoshiyama ◽

Miwa Ito ◽

Shozo Kaneko ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Three Dimensional ◽

Recording Site ◽

Contact Mapping ◽

Proximal Half ◽

Mapping System ◽

Endocardial Mapping ◽

Activation Sequence

Background: It has been suggested rotor which is located within the pulmonary vein (PV) acted as the driving sources of atrial fibrillation (AF). However, it has never been confirmed whether or not the rotor exists within PV in human. Objectives: We analyzed the activation sequence within the PV during AF and examined how the PV acted as the driving sources of AF. Methods: Selective endocardial mapping of left superior PV (LSPV) was performed during AF in 11 paroxysmal AF patients using a non-contact mapping system (EnSite 3000). Presence of rotor activation was defined when the circular activation around the functional block line once completed its whole reentrant activation. We analyzed the relation between the pivoting activation and the rotor activation. To define the preferable site of rotor and pivoting activation, we also analyzed the relation between the location of rotor and pivoting activation and region of the complex fractionated electrogram (CFE) recording site. Results: Rotor activation was observed with a mean number of 4.6±3.6 times/sec. CFE was observed at the roof (n=5), ridge (n=11) and carina (n=7) of the proximal half of LSPV with a mean area of 9.1±3.4 cm2. The number of rotor activation observed at the CFE area was significantly higher than that at the non-CFE area (4.1±3.9 vs. 0.7±1.2 times/sec, p=0.025). Total frequency of pivoting activation was 37.0±14.7 times/sec. Pivoting activation involved in the rotor activation was significantly lower than that not involved in the rotor activation (8.8±8.1 vs. 27.7±15.8 times/sec, p=0.0116). Regarding the CFE area, pivoting activation involved in the rotor activation was also significantly lower than that not involved in the rotor activation (8.4±8.2 vs. 24.1±12.0 times/sec, p=0.0105). However, there was no difference between the frequencies of pivoting activation with and without rotor activation in the non-CFE area (1.0±2.0 vs. 3.6±6.1 times/sec, p=NS). Conclusions: Rotor activation was observed at the proximal portion of the LSPV coincided with the location of CFE area. However, most of pivoting activation was not involved in the rotor activation. These suggest that AF was driven by the other meandering propagation associated with frequent non-stable pivoting activation over the CFE area.

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