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Benali K, Barré V, Hermida A, Galand V, Milhem A, Philibert S, Boveda S, Bars C, Anselme F, Maille B, André C, Behaghel A, Moubarak G, Clémenty N, Da Costa A, Arnaud M, Venier S, Sebag F, Jésel-Morel L, Sagnard A, Champ-Rigot L, Dang D, Guy-Moyat B, Abbey S, Garcia R, Césari O, Badenco N, Lepillier A, Ninni S, Boulé S, Maury P, Algalarrondo V, Bakouboula B, Mansourati J, Lesaffre F, Lagrange P, Bouzeman A, Muresan L, Bacquelin R, Bortone A, Bun SS, Pavin D, Macle L, Martins RP. Recurrences of Atrial Fibrillation Despite Durable Pulmonary Vein Isolation: The PARTY-PVI Study. Circ Arrhythm Electrophysiol 2023; 16:e011354. [PMID: 36802906 DOI: 10.1161/circep.122.011354] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are mainly due to pulmonary vein reconnection. However, a growing number of patients have AF recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown. We analyzed the impact of current ablation strategies in a large multicenter study. METHODS Patients undergoing a redo ablation for AF and presenting durable PVI were included. The freedom from atrial arrhythmia after pulmonary vein-based, linear-based, electrogram-based, and trigger-based ablation strategies were compared. RESULTS Between 2010 and 2020, 367 patients (67% men, 63±10 years, 44% paroxysmal) underwent a redo ablation for AF recurrences despite durable PVI at 39 centers. After durable PVI was confirmed, linear-based ablation was performed in 219 (60%) patients, electrogram-based ablation in 168 (45%) patients, trigger-based ablation in 101 (27%) patients, and pulmonary vein-based ablation in 56 (15%) patients. Seven patients (2%) did not undergo any additional ablation during the redo procedure. After 22±19 months of follow-up, 122 (33%) and 159 (43%) patients had a recurrence of atrial arrhythmia at 12 and 24 months, respectively. No significant difference in arrhythmia-free survival was observed between the different ablation strategies. Left atrial dilatation was the only independent factor associated with arrhythmia-free survival (HR, 1.59 [95% CI, 1.13-2.23]; P=0.006). CONCLUSIONS In patients with recurrent AF despite durable PVI, no ablation strategy used alone or in combination during the redo procedure appears to be superior in improving arrhythmia-free survival. Left atrial size is a significant predictor of ablation outcome in this population.
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Affiliation(s)
- Karim Benali
- CHU Saint Etienne, University of Rennes, INSERM, LTSI -UMR 1099, Rennes (K.B.)
| | - Valentin Barré
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | | | - Vincent Galand
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | | | | | - Serge Boveda
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, Toulouse (S.B.)
| | | | | | | | | | | | | | | | | | | | | | - Frédéric Sebag
- Rythmologie, Institut Mutualiste Montsouris, Paris (F.S.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Babé Bakouboula
- Institut Cardiovasculaire de Strasbourg, Clinique RHENA (B.B.)
| | | | | | | | | | | | | | | | | | - Dominique Pavin
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | - Laurent Macle
- Department of Medicine, Electrophysiology Service at the Montreal Heart Institute, Canada (L.M.)
| | - Raphaël P Martins
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
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von Alvensleben JC, Sandhu A, Chang S, Runciman DM, Wehrmann M, Tzou DW, Schäfer M, Collins KK. High-density electroanatomic mapping with grid catheter in pediatrics and congenital heart disease. J Interv Card Electrophysiol 2022; 66:611-619. [PMID: 36104612 DOI: 10.1007/s10840-022-01364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The Advisor™ HD Grid mapping catheter (Abbott Laboratories; Chicago, IL) allows for bipolar electrogram collection in both orthogonal and perpendicular planes, unique when compared to traditional and branch catheters. Experience in pediatric patients and congenital heart disease (CHD) is limited. The purpose of this work was to evaluate the utility and safety of the Advisor™ HD Grid mapping catheter in pediatric and CHD populations. METHODS Retrospective review of all pediatric patients and those with CHD (regardless of age) at Children's Hospital Colorado and University of Colorado undergoing electrophysiologic study in which the Advisor™ HD Grid mapping catheter was utilized. RESULTS Sixty-five procedures in 60 patients (N = 31 female (47.6%), median age 17 years (15-24.1)) were included. Patients had CHD in 30 procedures (46.1%). Eight-eight arrhythmia substrates were mapped including atrial flutter/intra-atrial reentrant tachycardia (N = 33), focal atrial tachycardia (N = 20), isolated PVCs (N = 10), accessory pathways (N = 9), atrioventricular nodal reentrant tachycardia (N = 7), right ventricular substrate mapping (N = 7), and ventricular tachycardia (N = 2). Median time per map was 11.8 (7.5-20.1) min with 3.2 (± 1.7) maps per procedure and a median of 2634 (1767-7654) points used per map. Patients with CHD required more maps (p < 0.001) and points per map (p < 0.001). Ablation was successful in 92.4% of procedures. CONCLUSIONS The Advisor™ HD Grid mapping catheter is safe and effective in the pediatric and congenital heart disease population. A wide variety of arrhythmia substrates can be mapped with high point density and low mapping time.
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Yeo C, Tan VH, Wang Y. Omnipolar activation EGM to identify the earliest breakout site of atrial tachycardia. J Arrhythm 2022; 38:801-804. [PMID: 36237860 PMCID: PMC9535805 DOI: 10.1002/joa3.12757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/20/2022] [Accepted: 07/03/2022] [Indexed: 11/05/2022] Open
Abstract
AT was mapped with Advisor HD Grid for earliest breakout site via local activation timing (LAT) map and Omnipolar map. While both maps point to earliest breakout site from low anterior right atrium, omnipolar map localised it to a more precise location compared to the earliest breakout site from LAT map. Ablation in this same spot rendered AT non inducible.
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Affiliation(s)
- Colin Yeo
- Department of CardiologyChangi General HospitalSingapore CitySingapore
| | - Vern Hsen Tan
- Department of CardiologyChangi General HospitalSingapore CitySingapore
| | - Yue Wang
- Department of CardiologyChangi General HospitalSingapore CitySingapore
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Drago F, Tamborrino PP, Porco L, Campisi M, Fanti V, Annibali R, Silvetti MS. Koch's triangle voltage mapping for cryoablation of slow pathway in children: preliminary data of a novel high-density technique. J Interv Card Electrophysiol 2021; 63:621-628. [PMID: 34697756 DOI: 10.1007/s10840-021-01081-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Different authors have described three-dimensional (3D) voltage mapping of the Koch's triangle (KT) in order to find low-voltage bridges (LVB) as targets for a successful transcatheter ablation (TCA) of the slow pathway (SP) in children. Recently, the Advisor High Density (HD) Grid™ mapping catheter was introduced as new multipolar catheter for HD mapping. The aim of the study was to describe our preliminary experience with the use of HD Grid™ catheter in LVB and electrophysiologically guided cryoablation of SP in children. METHODS Twenty-one children (mean age 13±3 years) with atrioventricular nodal re-entrant tachycardia (AVNRT) underwent cryoablation of SP guided by voltage HD mapping of the KT using HD Grid™ catheter. In order to better highlight the differences with conventional mapping, point collection was performed in each patient with this new multipolar catheter and with a quadripolar catheter. RESULTS The conventional mapping collected 871±262 points and used 211±80 points in 887±275 s, whereas HD mapping collected 7468±2947 points, using 604±165 points in 513±181 s (p<0.001). Moreover, the LVB area mapped with HD Grid™ was about one-half smaller and clearly delineated. Cryoablation acute success rate was 100%. Overall median fluoroscopy exposure was 0.08 (0.01-5.42) μGy/m2, with a median fluoroscopy time of 0.1 (0.0-0.6) min. During the follow-up (4.8 ± 3.7 months), there were no recurrences. No complications occurred. CONCLUSIONS Our preliminary experience shows that HD mapping is faster and offers higher spatial resolution and definition. Procedural time can be reduced maintaining the TCA safe, with reduced fluoroscopy use and success.
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Affiliation(s)
- Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery (European Reference Network for Rare and Low Prevalence Complex Disease of the Heart - ERN-Guard Heart), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Pietro Paolo Tamborrino
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery (European Reference Network for Rare and Low Prevalence Complex Disease of the Heart - ERN-Guard Heart), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Luigina Porco
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery (European Reference Network for Rare and Low Prevalence Complex Disease of the Heart - ERN-Guard Heart), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Marta Campisi
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery (European Reference Network for Rare and Low Prevalence Complex Disease of the Heart - ERN-Guard Heart), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Veronica Fanti
- Abbott, St Jude Abbott Medical Italia, Milan, Sesto San Giovanni, Italy
| | - Roberta Annibali
- Abbott, St Jude Abbott Medical Italia, Milan, Sesto San Giovanni, Italy
| | - Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery (European Reference Network for Rare and Low Prevalence Complex Disease of the Heart - ERN-Guard Heart), Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
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Lawing JG, Frix JT, Mrlik MS, Nilsson KR. Next-generation mapping with HD Grid and HD Wave. Future Cardiol 2021; 17:1183-1192. [PMID: 34003041 DOI: 10.2217/fca-2021-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
High-definition (HD) mapping with the Advisor HD Grid and HD Wave Solution software offers unparalleled resolution in mapping complex arrhythmias. The unique shape of a HD Grid (16 electrodes in a 4 × 4 pattern) allows for the mapping of orthogonal electrograms (EGMs). In so doing, the HD Grid catheter virtually eliminates the issue of 'bipolar blindness', a phenomenon seen when a wavefront of propagation is traveling perpendicular to a bipole pair. By improving the accuracy of the 3D electroanatomical map, HD Grid offers the potential of shorter procedure times, safer ablations and higher success rates. The following article explores the role of HD Grid in mapping a variety of arrhythmias including supraventricular tachycardias, atrial fibrillation and ventricular tachycardia. In addition, the authors explore the role of HD Grid in more recently described substrate-based advanced mapping techniques.
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Affiliation(s)
- Jacob G Lawing
- Department of Medicine, Department of Medicine, Augusta University-University of Georgia Medical Partnership, Athens, GA 30606, USA
| | - James T Frix
- Department of Medicine, Department of Medicine, Augusta University-University of Georgia Medical Partnership, Athens, GA 30606, USA
| | - Matthew S Mrlik
- Department of Internal Medicine, Piedmont Heart Institute, Piedmont Athens Regional, Athens, GA 30606, USA
| | - Kent R Nilsson
- Department of Medicine, Department of Medicine, Augusta University-University of Georgia Medical Partnership, Athens, GA 30606, USA.,Department of Internal Medicine, Piedmont Heart Institute, Piedmont Athens Regional, Athens, GA 30606, USA
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Hohendanner F, Kuhlmann S, Blaschke F, Lacour P, Dimai S, Pieske B, Boldt LH, Parwani AS. Quantitative evaluation of different high-density 3D mapping modes for atrial and ventricular substrate assessment of cardiac arrhythmias with the HD grid catheter. J Electrocardiol 2020; 63:110-114. [PMID: 33181453 DOI: 10.1016/j.jelectrocard.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Atrial and ventricular arrhythmias significantly contribute to morbidity and mortality of patients with cardiac disease. Ablation of these arrhythmias has shown to improve clinical outcomes, yet targeted ablation strategies rely on proper mapping capabilities. In the present study, we compare different modes of high-resolution mapping in clinically relevant arrhythmias using HD grid. METHODS AND RESULTS Using the Advisor™ HD Grid Mapping Catheter in either the standard, the wave (bipolar along spline and bipolar orthogonal) or the wave diagonal setting, low-voltage areas were determined. Low-voltage was defined as local electrograms with an amplitude <0.5 mV (bipolar; atria/ventricle) or <4 mV (unipolar; ventricle). Ultra high-density mapping in 47 patients with ventricular tachycardia, ventricular premature beats, atrial fibrillation and atrial tachycardia provided reliable information for the understanding of the arrhythmia mechanism resulting in safe ablation procedures. Regions of low voltage were significantly decreased by 14 ± 2% and 31 ± 3% with wave and wave diagonal settings as compared to standard settings, respectively. CONCLUSION Substrate mapping and risk stratification relies on proper low voltage discrimination. Even though the Advisor™ HD Grid Mapping Catheter was safely used in all cases, the extent of low voltage areas was mapping-mode dependent.
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Affiliation(s)
- Felix Hohendanner
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Stefan Kuhlmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Florian Blaschke
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Philipp Lacour
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Sanzio Dimai
- Paracelsus Medizinische Privatuniversität Nürnberg, Nuremberg, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany; Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany
| | - Leif-Hendrik Boldt
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Abdul S Parwani
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany.
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7
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Chieng D, Lahiri A, Sugumar H, Al‐Kaisey A, Parameswaran R, Anderson RD, Prabhu S, Ling L, Morton JB, McLellan AJ, Lee G, Kalman JM, McGavigan AD, Kistler PM. Multipolar mapping with the high‐density grid catheter compared with conventional point‐by‐point mapping to guide catheter ablation for focal arrhythmias. J Cardiovasc Electrophysiol 2020; 31:2288-2297. [DOI: 10.1111/jce.14636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- David Chieng
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | | | - Hariharan Sugumar
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | - Ahmed Al‐Kaisey
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Ramanathan Parameswaran
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Robert D. Anderson
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Sandeep Prabhu
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | - Liang‐Han Ling
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | - Joseph B. Morton
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Alex J. McLellan
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Geoffrey Lee
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Jonathan M. Kalman
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
- Department of Medicine Monash Health Melbourne Australia
| | - Andrew D. McGavigan
- Department of Cardiology Flinders Medical Centre Adelaide Australia
- Faculty of Medicine Flinders University Adelaide Australia
| | - Peter M. Kistler
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Medicine Monash Health Melbourne Australia
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8
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Porterfield C, J Gora P, Wystrach A, Rossi P, Rillo M, A Sebag F, Giuggia M, Mantica M, Dorszewski A, Eldadah Z, Volpicelli M, Bottoni N, Jøns C, T Hollis Z, Dekker L, Mathew S, Schmitt J, Nilsson K. Confirmation of Pulmonary Vein Isolation with High-Density Mapping: Comparison to Traditional Workflows. J Atr Fibrillation 2020; 12:2361. [PMID: 33024494 DOI: 10.4022/jafib.2361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/11/2019] [Accepted: 10/12/2019] [Indexed: 02/03/2023]
Abstract
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Yet tools and techniques used for confirmation of PVI vary greatly, and it is unclear whether the use of any particular combination of tools and techniques provides greater sensitivity for identifying gaps periprocedurally. It has been suggested the use of a high-density mapping catheter, which enables simultaneous recording of adjacent bipolar EGMs in two directions, may provide improved sensitivity for gap identification. Anonymized, acute procedural data was prospectively collected in AF ablation cases utilizing various workflows for confirmation of PVI. Post-hoc analysis was performed to evaluate the incidence of gaps detected by different diagnostic catheter technologies, including a high-density mapping catheter and circular mapping catheters (CMCs), and common techniques such as pacing the ablation lines. A total of 139 cases were included across three subgroup analyses: 99 cases were included in an indirect comparison of three mapping catheter technologies, revealing gaps in 36.7%, 38.9%, and 81.8% of cases utilizing a 10-pole CMC, 20-pole CMC, and a high-density mapping catheter, respectively; a direct comparison of diagnostic catheter technologies in 18 cryoballoon ablation cases revealed residual gaps in 22.2% of patients identified by high-density mapping which were missed previously with the use of a 3.3F CMC; in 22 cases utilizing a technique of pacing the ablation lines, high-density mapping identified residual gaps in 68.2% of patients. This proof of concept analysis demonstrated that the use of a high-density catheter which records orthogonal bipoles simultaneously, appears to improve acute detection of gaps in PVI lines relative to other commonly utilized techniques and technologies. The long-term impact of ablating these concealed gaps remains unclear. Further study, including direct comparison of diagnostic catheter technologies in a randomized setting with long-term followup, is warranted.
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Affiliation(s)
| | | | | | - Pietro Rossi
- S. Giovanni Calibita FateBeneFratelli - Isola Tiberina, Rome, Italy
| | | | - Frederic A Sebag
- Institut Mutualiste Montsouris, Departement de Cardiologie, Paris, France
| | | | | | | | - Zayd Eldadah
- Medstar Washington Hospital Center, Washington D.C., USA
| | | | | | | | | | - Lukas Dekker
- Catharina Ziekenhuis Eindhoven, Eindhoven, Netherlands
| | | | | | - Kent Nilsson
- Piedmont Athens Regional Medical Center, Athens, GA, USA
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9
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Kumagai K. Editorial to utility of directional high-density mapping catheter (Advisor HD Grid) in complex scar-related atrial tachycardia. J Arrhythm 2020; 36:184-185. [PMID: 32071640 PMCID: PMC7011816 DOI: 10.1002/joa3.12272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Koji Kumagai
- Department of Cardiovascular MedicineTohoku Medical and Pharmaceutical UniversityMiyagiJapan
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10
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Tan VH, Lyu MZ, Tan PC, Wong LC, Yeo C, Wong KCK. Utility of directional high-density mapping catheter (Advisor TM HD Grid) in complex scar-related atrial tachycardia. J Arrhythm 2020; 36:180-183. [PMID: 32071639 PMCID: PMC7011828 DOI: 10.1002/joa3.12256] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/24/2019] [Accepted: 10/17/2019] [Indexed: 11/09/2022] Open
Abstract
Mapping of scar-related atrial tachycardias (AT) can be challenging even with the use of high-density (HD) mapping catheter. AdvisorTM HD Grid is the only directional HD mapping catheter which not only identify local electrical signal but more importantly capture the direction of wave front propagation especially in low voltage zone. Accordingly, we present a case of complex scar-related AT with the use of AdvisorTM HD Grid which showed clear fractionated signal at isthmus area as compare to the absence of signal on ablation catheter at the same area despite adequate contact force. Ablation at this area terminated the tachycardia.
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Affiliation(s)
- Vern Hsen Tan
- Cardiology DepartmentChangi General HospitalSingapore
| | | | | | | | - Colin Yeo
- Cardiology DepartmentChangi General HospitalSingapore
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11
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Frisch DR. Identifying a Gap in a Cavotricuspid Isthmus Flutter Line Using the Advisor™ HD Grid High-Density Mapping Catheter. J Innov Card Rhythm Manag 2019; 10:3919-3922. [PMID: 32477713 PMCID: PMC7252717 DOI: 10.19102/icrm.2019.111202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/05/2019] [Indexed: 12/05/2022] Open
Abstract
This report discusses the mapping of an incomplete cavotricuspid isthmus flutter line with a high-density mapping catheter to visualize the arrhythmogenic substrate responsible for incomplete block. The relevant signals were unapparent when using a traditional ablation catheter but were evident with application of a high-density mapping catheter. High-density mapping holds promise for recording electrograms in gaps in other ablation lesion sets that may not be able to be easily identified using more traditional equipment alone.
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12
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Masuda M, Asai M, Iida O, Okamoto S, Ishihara T, Nanto K, Kanda T, Tsujimura T, Matsuda Y, Okuno S, Hata Y, Mano T. Left atrial voltage mapping with a direction-independent grid catheter: Comparison with a conventional circular mapping catheter. J Cardiovasc Electrophysiol 2019; 30:2834-2840. [PMID: 31701587 DOI: 10.1111/jce.14263] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/24/2019] [Accepted: 11/03/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A recently introduced grid mapping catheter (GMC) is designed for better electrode-tissue contact and can collect bipolar signals both along and across the splines, which may allow more efficient voltage map generation independent of propagation direction. We compared the GMC with a conventional circular mapping catheter (CMC) for left atrial (LA) voltage mapping. METHODS This study included 20 consecutive patients undergoing repeat ablation for recurrent atrial fibrillation who had demonstrated LA low-voltage areas (LVAs, <0.10 mV). Following pulmonary vein isolation, LA voltage mapping was performed twice, once using the GMC and once using the CMC. RESULTS Voltage mapping was more efficient using the GMC than the CMC in terms of mapping time (459 [404, 543] vs 602 [496, 814] seconds; P = .014) and the number of mapping points (2446 [2099, 3104] vs 1841 [1494, 2314]; P = .002). The incidence of catheter-induced ectopies was lower (44 [28, 62] vs 114 [74, 188]; P < .0001) using the GMC. The GMC utilizing all bipoles detected LVAs in 85% of patients with LVAs detected by CMC. LVA measurements were significantly smaller on maps generated by the GMC using bipoles along or across the splines than those measured with the CMC (11.1 [4.6, 17.2] or 9.7 [2.5, 16.0] vs 16.4 [6.8, 26.8] cm2 ; P = .008 and P = .001, respectively), and were even smaller when using all bipoles (7.9 [1.1, 13.5] cm2 , P = .0001). CONCLUSION The GMC allowed a more efficient mapping procedure and enabled more selective identification of LVAs with smaller LVA size.
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Affiliation(s)
- Masaharu Masuda
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Mitsutoshi Asai
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Osamu Iida
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | | | - Kiyonori Nanto
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Takashi Kanda
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | | | | | - Shota Okuno
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Yosuke Hata
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
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Enhanced ventricular tachycardia substrate resolution with a novel omnipolar high-density mapping catheter: the omnimapping study. J Interv Card Electrophysiol 2019; 58:355-362. [PMID: 31598876 DOI: 10.1007/s10840-019-00625-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Defining diastolic slow-conduction channels within the borderzone (BZ) of scar-dependent re-entrant ventricular tachycardia (VT) is key for effective mapping and ablation strategies. Understanding wavefront propagation is driving advances in high-density (HD) mapping. The newly developed Advisor™ HD Grid Mapping Catheter (HD GRID) has equidistant spacing of 16, 1 mm electrodes in a 4 × 4 3 mm interspaced arrangement allowing bipolar recordings along and uniquely across the splines (orthogonal vector) to facilitate substrate mapping in a WAVE configuration (WAVE). The purpose of this study was to determine the relative importance of the WAVE configuration compared to the STANDARD linear-only bipolar configuration (STANDARD) in defining VT substrate. METHODS Thirteen patients underwent VT ablation at our institution. In all cases, a substrate map was constructed with the HD GRID in the WAVE configuration (conWAVE) to guide ablation strategy. At the end of the procedure, the voltage map was remapped in the STANDARD configuration (conSTANDARD) using the turbo-map function. Detailed post-hoc analysis of the WAVE and STANDARD maps was performed blinded to the configuration. Quantification of total scar area, BZ and dense scar area with assessment of conduction channels (CC) was performed. RESULTS The substrate maps conSTANDARD vs conWAVE showed statistically significant differences in the total scar area (56 ± 32 cm2 vs 51 ± 30 cm2; p = 0.035), dense scar area (36 ± 25 cm2 vs 29 ± 22 cm2; p = 0.002) and number of CC (3.3 ± 1.6 vs 4.8 ± 2.5; p = 0.026). conWAVE collected more points than the conSTANDARD settings (p = 0.001); however, it used fewer points in map construction (p = 0.023). CONCLUSIONS The multipolar Advisor™ HD Grid Mapping Catheter in conWAVE provides more efficient point acquisition and greater VT substrate definition of the borderzone particularly at the low-voltage range compared to conSTANDARD. This greater resolution within the low-voltage range facilitated CC definition and quantification within the scar, which is essential in guiding the ablation strategy.
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Drago F, Calvieri C, Allegretti G, Silvetti MS. Mapping of low-voltage bridges with a high-density multipolar catheter in a child with atrioventricular nodal reentry tachycardia. HeartRhythm Case Rep 2019; 6:8-10. [PMID: 31956493 PMCID: PMC6962720 DOI: 10.1016/j.hrcr.2019.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmias/Syncope Unit, Bambino Gesu Children's Hospital and Research Institute, Rome, Italy
| | - Camilla Calvieri
- Paediatric Cardiology and Cardiac Arrhythmias/Syncope Unit, Bambino Gesu Children's Hospital and Research Institute, Rome, Italy
| | - Greta Allegretti
- Abbott, St Jude, Abbott Medical Italia S.p.A., Agrate Brianza, Italy
| | - Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmias/Syncope Unit, Bambino Gesu Children's Hospital and Research Institute, Rome, Italy
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