High Density 3D Mapping and Ablation of Complex Cardiac Arrhythmias: Our Experience in NICVD

Background: Catheter ablation can be curative in patients with drug-refractory tachyarrhythmias. 3D electro anatomical mapping (EAM) is an established tool facilitating catheter ablation. This system is particularly valuable for mapping complex arrhythmias, which provide excellent assistance to catheter navigation, reduces fluoroscopy exposure, and also allow for the accurate placement of catheters. The Rhythmia Mapping System (RMS, Boston Scientific) is a novel system that allows for ultra-fast, high-density 3D mapping. Aim of this Study: The aim of this study was to find out the result of a high-density 3D mapping for the ablation of complex Cardiac Arrhythmias and to share our experiences. Methods: A total number of 44 patients of different tachyarrhythmias were scheduled for catheter ablation by Rhythmia Mapping System in National Institute of Cardiovascular Diseases, Bangladesh from 3rd February’2018 to 18th July’2019. During and after, the procedure all the cases were evaluated for different procedure parameters, acute success and in-hospital success. Results: Among the patients (28/44 male) 13 (25.55%) cases were atrial fibrillation, 6 (16.64%) cases were atrial flutter, 6 (16.64%) cases were atrial tachycardia, 2 (4.55%) cases were ventricular tachycardia, 11 (25%) cases were PVC and 6 (16.64%) cases were accessory pathway. The mean age was 38±4.5 years. In 25 (56.82%) of tachyarrhythmia patients, the mechanism was macro reentry/micro reentry, while in 19 (43.18%) cases the mechanism was increased automaticity. In all cases, the tachycardias were adequately mapped & proper identification of focus was done during the index procedure with the ultra-high density 3-D Rhythmia Mapping System (RMS). These all were successfully terminated by radiofrequency ablation, except one, which was one of the two cases of Ventricular tachycardia. With this system our study samples had a success rate of 98% with arrhythmia elimination. In patients of atrial fibrillation, all 4 pulmonary veins isolation were done. The mean mapping time was 28.6 ± 17 minutes, and the mean radiofrequency ablation time to arrhythmia termination was 3.2± 2.6 minutes. During our study only two out of 44 patients developed complications. One of the patients with atrial fibrillation developed cardiac tamponade and the other patient with PVC originating from Aortic cusp developed ischemic stroke. Fortunately, they were both managed accordingly. During hospital discharge, all the patients were free of tachyarrhythmia and were in sinus rhythm. Conclusions: This new automated ultrahigh-resolution mapping system allows accurate diagnosis of tachyarrhythmia circuits. Ablation of the focus resulted in high acute success. Bangladesh Heart Journal 2021; 36(2): 98-104

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Safety and outcome of cryoballoon ablation versus radiofrequency catheter ablation of the pulmonary veins in patients with paroxysmal atrial fibrillation

QJM ◽

10.1093/qjmed/hcaa041.027 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

O H M A Riad ◽

T Wong ◽

A N Ali ◽

M T Ibrahim ◽

M A Abdelhamid ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Paroxysmal Atrial Fibrillation ◽

Pulmonary Veins ◽

Cryoballoon Ablation ◽

The Mean

Abstract Background Pulmonary vein isolation (PVI) has become the mainstay of catheter ablation of atrial fibrillation (AF). There are two commonly used methods to isolate the pulmonary veins, either point-by-point delivery of circumferential lesion sets around ipsilateral pulmonary veins using radiofrequency energy, or the application of the cryoballoon to the pulmonary vein antrum with occlusion of the vein ostium. The cryoballoon has proven to be a reliable alternative to radiofrequency ablation in acute and long-term freedom from AF. We describe our results using both modalities. Aim and Objectives to compare the safety and efficacy of cryoballoon (CB) ablation and radiofrequency (RF) ablation in treatment of paroxysmal atrial fibrillation. Patients and Methods Forty-four consecutive patients having paroxysmal AF underwent PVI using the second generation cryoballoon were compared to a retrospective cohort of 69 patients who had radiofrequency induced PVI, either by conventional RF catheter (n = 32), or a contact-force sensing-catheter (n = 37). The study took place at Ain Shams university hospitals and Royal Brompton & Harefield NHS trust. Patient data, procedural data and follow up data- at 3, 6 and 12 months- were collected and analysed. Recurrence was defined as documented AF or atrial arrhythmias with duration exceeding 30 seconds, either by 12 lead ECG or an ambulatory monitoring device. Results A total of 113 patients were studied. The mean age was 53.84 ± 15.01 for the CB group and 55.78 ± 14.84 for the RF group and females representing 40.9% vs 34.8% respectively. The mean procedural times in minutes were significantly less in the CB group (94.37 ± 39.32 vs 184.57 ± 88.19, p < 0.0001), while the median fluoroscopy times were similar [30 (11.04 - 40) vs 37.25 (14.2 - 70), p = 0.172]. Procedural complications were comparable between the two groups (p = 0.06) with 1 patient (2.3%) having long term phrenic nerve paresis. At 1 year follow up, after an initial 90-day blanking period, recurrence rate of CB was similar to RF (27.3% vs 30.4% respectively, p = 0.719), the Kaplan Meier estimates of AF- free survival for a period of 1 year were comparable between both groups (log rank test, p = 0.606). Conclusion Cryoballoon is a feasible method for pulmonary vein isolation with similar success rates to radiofrequency ablation. Cryoballoon ablation is safe with shorter duration of the procedure.

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Ultra-fast, high-density 3D mapping system for catheter ablation of infrequent, “unmappable” idiopathic ventricular arrhythmia – a case report.

Heart Beat Journal ◽

10.24255/hbj/67449 ◽

2016 ◽

Vol 1 ◽

pp. 6-8

Author(s):

Radosław Lenarczyk ◽

Oskar Kowalski ◽

Michał Mazurek ◽

Zbigniew Kalarus

Keyword(s):

Case Report ◽

Catheter Ablation ◽

Ventricular Arrhythmia ◽

High Density ◽

3D Mapping ◽

Mapping System ◽

3D Mapping System

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Ultra–fast, high density 3D mapping system for catheter ablation of atypical atrial flutter.

Heart Beat Journal ◽

10.24255/hbj/100680 ◽

2018 ◽

Vol 3 ◽

pp. 80-82

Author(s):

Jonasz Kozielski ◽

Oskar Kowalski ◽

Ewa Jędrzejczyk-Patej ◽

Radosław Lenarczyk ◽

Aleksandra Konieczny ◽

...

Keyword(s):

Catheter Ablation ◽

Atrial Flutter ◽

High Density ◽

3D Mapping ◽

Mapping System ◽

3D Mapping System

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Six-months success of radiofrequency ablation in cardiac arrhythmias treatment: Experience of our centre

Vojnosanitetski pregled ◽

10.2298/vsp170125109j ◽

2019 ◽

Vol 76 (4) ◽

pp. 398-403

Author(s):

Ruzica Jurcevic-Mudric ◽

Lazar Angelkov ◽

Milosav Tomovic ◽

Dejan Kojic ◽

Predrag Milojevic

Keyword(s):

Atrial Fibrillation ◽

Ventricular Tachycardia ◽

Radiofrequency Ablation ◽

Atrial Flutter ◽

Cardiac Arrhythmias ◽

Paroxysmal Atrial Fibrillation ◽

Atrial Tachycardia ◽

Pulmonary Veins ◽

Av Node

Background/Aim. Numerous trials have shown a high success of radiofrequency ablation (RFA) in the treatment of the patients with cardiac arrhythmias. We aimed to examine the RFA initial success in treatment of different cardiac arrhythmias and the RFA success after 6 months of followup. Second aim was to evaluate influence of all clinical and echocardiography parameters on initial and 6-month success and failure of RFA. Methods. The present study included 320 consecutive patients with atrial and ventricular arrhythmias in which RFA was performed during 2014 in the Institute for Cardiovascular Diseases ?Dedinje?, Belgrade, Serbia. We evaluated the initial RFA success and success of this procedure after 6-month follow-up. We also investigated the prognostic role of clinical and echocardiography parameters on initial and 6-month success and failure of RFA. Results. The RFA initial success for RFA of atrioventriculas (AV) node and AV nodal reentrant tachycardia (AVNRT) was 100%, RFA of pulmonary veins 99%, RFA of atrial flutter 92%, RFA of premature ventricular complexes (PVC) and the Wolf-Parkinson-White (WPW) syndrome 87%, RFA of ventricular tachycardia 85% and RFA of atrial tachycardia 78%. The success of RFA after 6 months of follow-up for RFA of the AV node was 100%, RFA of AVNRT 94%, RFA of atrial flutter 90%, RFA of WPW syndrome 86%, RFA of pulmonary veins 79% (paroxysmal atrial fibrillation 88% and persistent atrial fibrillation 63% with a significant difference p < 0.05), RFA of PVC 78%, RFA of ventricular tachycardia 77% and RFA of atrial tachycardia 67%. Conclusion. This study proved a very high RFA initial success in treatment of cardiac arrhythmias and a satisfactory RFA success after 6 months of follow-up. Only the prognostic value had the type of atrial fibrillation in the group with catheter ablated pulmonary veins: after 6-month follow-up, the patients with paroxysmal atrial fibrillation had a significantly better outcome than those with persistent form.

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Ultra-fast, high density 3D mapping (Rhythmia Mapping System) and catheter radiofrequency ablation for electrical storm – early single centre experience

Heart Beat Journal ◽

10.24255/hbj/68137 ◽

2017 ◽

Vol 1 ◽

pp. 35-40

Author(s):

Radosław Lenarczyk ◽

Patrycja Pruszkowska ◽

Stanisław Morawski ◽

Michał Mazurek ◽

Beata Średniawa ◽

...

Keyword(s):

Radiofrequency Ablation ◽

High Density ◽

Electrical Storm ◽

3D Mapping ◽

Single Centre ◽

Mapping System ◽

Single Centre Experience

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Economic evaluation of an ultra-high density mapping system compared to non-ultra-high density mapping systems for radiofrequency catheter ablation procedures in patients with atrial fibrillation

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-021-00951-x ◽

2021 ◽

Author(s):

Bernardo Wise ◽

Ramón Albarrán-Rincón ◽

Alfonso De Lossada Juste ◽

Ane Erkiaga Aio ◽

Armin Klesius ◽

...

Keyword(s):

Atrial Fibrillation ◽

Economic Evaluation ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

High Density ◽

Density Mapping ◽

Mapping System ◽

Mapping Systems

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

Circulation ◽

10.1161/01.cir.100.11.1203 ◽

1999 ◽

Vol 100 (11) ◽

pp. 1203-1208 ◽

Cited By ~ 192

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

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Catheter ablation of left posterior fascicular ventricular tachycardia in children with limited fluoroscopy exposure

Cardiology in the Young ◽

10.1017/s1047951119000830 ◽

2019 ◽

Vol 29 (06) ◽

pp. 793-799

Author(s):

Serhat Koca ◽

Celal Akdeniz ◽

Mehmet Karacan ◽

Volkan Tuzcu

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Three Dimensional ◽

Electroanatomic Mapping ◽

Electroanatomic Mapping System ◽

Ventricular Tachycardia Ablation ◽

Left Posterior ◽

Mapping System ◽

The Mean ◽

Fluoroscopy Exposure

AbstractIntroduction:Catheter ablation of left posterior fascicular ventricular tachycardia in the pediatric population remains challenging, and most studies about this topic have been conducted on adult patients. This study aimed to assess the clinical presentation features and outcomes of catheter ablations performed using limited fluoroscopy with three-dimensional electroanatomic mapping system guidance in a pediatric left posterior fascicular ventricular tachycardia patient group.Methods:A total of 20 consecutive patients undergoing left posterior fascicular ventricular tachycardia ablation at a single tertiary centre were enrolled. All children with left posterior fascicular ventricular tachycardia underwent electrophysiological studies using the EnSite NavX system guidance. Ablations were performed during the sinus rhythm based on the Purkinje potentials in all patients.Results:The mean patient age was 12.7 years (range 2–16), and the mean patient weight was 51 kg (range 11–84). The mean procedure and median fluoroscopy times were 143.1 minutes and 3.4 minutes, respectively. No fluoroscopy was used in three patients. Acute success was achieved in 19 patients (95%). During a mean follow-up of 38.6 ± 19.35 months, left posterior fascicular ventricular tachycardia recurred in four patients (20%). Repeat ablations were performed successfully in those patients who developed recurrences. No complications were seen.Conclusions:Catheter ablation of left posterior fascicular ventricular tachycardia in children can be performed safely and effectively with low fluoroscopy exposure using a three-dimensional electroanatomic mapping system.

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