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 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 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 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.

scholarly journals A Divergence-Based Approach for the Identification of Atrial Fibrillation Focal Drivers From Multipolar Mapping: A Computational Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Michela Masè ◽  
Alessandro Cristoforetti ◽  
Maurizio Del Greco ◽  
Flavia Ravelli
Keyword(s):  
Atrial Fibrillation ◽  
Vector Fields ◽  
Computational Study ◽  
Pulmonary Veins ◽  
Proof Of Concept ◽  
Activation Time ◽  
Mapping Data ◽  
Activation Patterns ◽  
Novel Approach

The expanding role of catheter ablation of atrial fibrillation (AF) has stimulated the development of novel mapping strategies to guide the procedure. We introduce a novel approach to characterize wave propagation and identify AF focal drivers from multipolar mapping data. The method reconstructs continuous activation patterns in the mapping area by a radial basis function (RBF) interpolation of multisite activation time series. Velocity vector fields are analytically determined, and the vector field divergence is used as a marker of focal drivers. The method was validated in a tissue patch cellular automaton model and in an anatomically realistic left atrial (LA) model with Courtemanche–Ramirez–Nattel ionic dynamics. Divergence analysis was effective in identifying focal drivers in a complex simulated AF pattern. Localization was reliable even with consistent reduction (47%) in the number of mapping points and in the presence of activation time misdetections (noise <10% of the cycle length). Proof-of-concept application of the method to human AF mapping data showed that divergence analysis consistently detected focal activation in the pulmonary veins and LA appendage area. These results suggest the potential of divergence analysis in combination with multipolar mapping to identify AF critical sites. Further studies on large clinical datasets may help to assess the clinical feasibility and benefit of divergence analysis for the optimization of ablation treatment.

scholarly journals 1014-211 Activation mapping of pulmonary veins during initiation of atrial fibrillation using a multielectrode basket catheter

2004 ◽  
Vol 43 (5) ◽  
pp. A105-A106
Author(s):  
Koichiro Kumagai ◽  
Masahiro Ogawa ◽  
Hiroo Noguchi ◽  
Tomoo Yasuda ◽  
Keijiro Saku
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Basket Catheter ◽  
Activation Mapping

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

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 Octogenarian Atrial Fibrillation Ablation with New NavX EnSite “Live View” Tool

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Mariano Rillo ◽  
Zefferino Palamà ◽  
Francesco Zonno ◽  
Giulia My ◽  
Raffaele Punzi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Older Patients ◽  
Pulmonary Veins ◽  
Atrial Fibrillation Ablation ◽  
Voltage Mapping ◽  
Mapping System ◽  
Procedural Time ◽  
Procedural Complications ◽  
Tailored Approach

Background. Atrial Fibrillation ablation in older patients represents a challenge to be addressed to ensure the improvement of the quality of life and survival of these patients. New mapping system tools can help to treat older patients because of its ability to simplify and reduce procedural risks. The new NavX EnSite “Live view” tool allows dynamic “beat to beat” activation and voltage mapping visualization in order to instantly recognize vein disconnection and minimize RF deliveries. Methods. An 81-year old patient with paroxysmal AF and well-documented firing focus trigger underwent pulmonary veins isolation using NavX EnSite Precision, HD Grid multipolar catheter, and the new “Live view” tool. Results. All pulmonary veins were successfully isolated with no procedural complications. “Live view” tool allows to perform shorter and safer procedure (total procedural time: 90 minutes, left atrium dwell time: 60 minutes, total RF delivery number: 78). Conclusion. “Live view tool” allows dynamic activation and voltage mapping in order to perform a safe and tailored approach to ablation, especially in older patients.

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