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Hindricks G, Weiner S, McElderry T, Jaïs P, Maddox W, Garcia-Bolao JI, Yong Ji S, Sacher F, Willems S, Mounsey J, Maury P, Bollmann A, Duffy E, Raciti G, Tung R, Wong T. Acute safety, effectiveness, and real-world clinical usage of ultra-high density mapping for ablation of cardiac arrhythmias: results of the TRUE HD study. Europace 2020; 21:655-661. [PMID: 30815690 PMCID: PMC6452400 DOI: 10.1093/europace/euy191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/04/2018] [Indexed: 11/12/2022] Open
Abstract
AIMS The objective of this study was to verify acute safety, performance, and usage of a novel ultra-high density mapping system in patients undergoing ablation procedure in a real-world clinical setting. METHODS AND RESULTS The TRUE HD study enrolled patients undergoing catheter ablation with mapping for all arrhythmias (excluding de novo atrial fibrillation) who were followed for 1 month. Safety was determined by collecting all serious adverse events and adverse events associated with the study devices. Performance was determined as the composite of: ability to map the arrhythmia/substrate, complete the ablation applications, arrhythmia termination (where applicable), and ablation validation. Use of mapping system in the ablation validation workflow was also evaluated. Among the 519 patients who underwent a complete (504) or attempted (15) procedure, 21 (4%) serious ablation-related complications were collected, with 3 (0.57%) potentially related to the mapping catheter. Four hundred and twenty treated patients resulted in a successful procedure confirmed by arrhythmia-specific validation techniques (83.3%; 95% confidence interval: 79.8-86.5%). A total of 1419 electroanatomical maps were created with a median acquisition time of 9:23 min per map. Of these, 372 maps in 222 (44%) patients were collected for ablation validation purposes. Following validation mapping, 162/222 (73%) patients required additional ablation. CONCLUSION In the TRUE HD study mapping was associated with rates of acute success and complications consistent with previously published reports. Importantly, a low percentage of events (0.57%) was attributed to the mapping catheter. When performed, validation mapping was useful for identifying additional targets for ablation in the majority of patients.
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Affiliation(s)
- Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, Strümpellstr., Leipzig, Germany
| | - Stanislav Weiner
- Clinic Electrophysiology Department, Trinity Mother Frances, Tyler, TX, USA
| | - Tom McElderry
- Cardiac Electrophysiology, Division of Cardiovascular Disease, University of Alabama Birmingham, Birmingham, AL, USA
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit, University of Bordeaux, CHU Bordeaux, IHU LIRYC, Bordeaux, France
| | - William Maddox
- Cardiac Electrophysiology, Division of Cardiovascular Disease, University of Alabama Birmingham, Birmingham, AL, USA
| | | | - Sang Yong Ji
- Cardiac Electrophysiology, Division of Cardiology, Torrance Memorial Medical Center, Torrance, CA, USA
| | - Frederic Sacher
- Electrophysiology and Ablation Unit, University of Bordeaux, CHU Bordeaux, IHU LIRYC, Bordeaux, France
| | - Stephan Willems
- Department of Cardiac Electrophysiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - John Mounsey
- Division of Cardiology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Philippe Maury
- Division of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig, Strümpellstr., Leipzig, Germany
| | | | | | - Roderick Tung
- Center for Arrhythmia Care, Heart and Vascular Center, The University of Chicago Medicine, Chicago, IL, USA
| | - Tom Wong
- Heart Rhythm Centre, Royal Brompton and Harefield foundation Trust and Imperial College, London, UK
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Mori H, Muraji S, Sumitomo N, Kato R, Imamura T, Komori A, Iwashita N, Kobayashi T, Matsumoto K. Safety and accuracy of the Rhythmia mapping system in pediatric patients. Heart Rhythm 2018; 16:388-394. [PMID: 30308251 DOI: 10.1016/j.hrthm.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND A new mapping system (Rhythmia) using a 64 mini-electrode small basket array (Orion) was developed that enables rapid high-density mapping in a short time. However, there are few reports about the usefulness of this system in pediatric cases. OBJECTIVE The purpose of this study was to investigate the safety and accuracy of the Rhythmia system and Orion catheter in children. METHODS Catheter ablation was performed using the Rhythmia system and Orion catheter in 23 patients younger than 20 years (body weight >20 kg) without a past medical history of cardiac disease. Mapping time, number of mapping beats, and number of mapping electrodes were compared for left atrium, right atrium and right ventricular outflow tract. RESULTS Twenty-three maps of the right atrium were acquired in 12.6 minutes (range 8.9-15.1), consisting of 709 beats (range 492-1163) and 7132 electrograms (range 4618-10,533). Twelve maps of the left atrium were acquired in 12.1 minutes (range 9.8-14.6), consisting of 565 beats (range 446-881) and 6412 electrograms (range 4912-11,402). There were no significant difference in mapping time, accepted beats, and electrograms between the 2 chambers. Manual annotation was needed in 53 of 293,185 electrograms (0.01%) due to far-field ventricular electrogram sensing and artifact. No adverse events occurred in any of the cases. CONCLUSION The Orion catheter and Rhythmia mapping system were safe and accurate for mapping various arrhythmias in pediatric patients. Detailed geometry and high-resolution activation mapping were acquired without the need for manual reannotation.
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Affiliation(s)
- Hitoshi Mori
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomohiko Imamura
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akiko Komori
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Noriyuki Iwashita
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshiki Kobayashi
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazuo Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
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Walsh KA, Galvin J, Keaney J, Keelan E, Szeplaki G. Automated ultra-high-density mapping of peri-sinus node premature atrial contractions. Clin Res Cardiol 2017; 107:368-370. [PMID: 29222593 DOI: 10.1007/s00392-017-1191-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Katie A Walsh
- Heart and Vascular Centre, Mater Private Hospital, 72 Eccles Street, Dublin 7, Ireland
| | - Joseph Galvin
- Heart and Vascular Centre, Mater Private Hospital, 72 Eccles Street, Dublin 7, Ireland
| | - John Keaney
- Heart and Vascular Centre, Mater Private Hospital, 72 Eccles Street, Dublin 7, Ireland
| | - Edward Keelan
- Heart and Vascular Centre, Mater Private Hospital, 72 Eccles Street, Dublin 7, Ireland
| | - Gabor Szeplaki
- Heart and Vascular Centre, Mater Private Hospital, 72 Eccles Street, Dublin 7, Ireland. .,Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.
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Kosiuk J, Hilbert S, John S, Bertagnolli L, Hindricks G, Bollmann A. Preliminary experience with high-density electroanatomical mapping for ablation of atrial fibrillation – Comparison of mini-basket and novel open irrigated magnetic ablation catheter in consecutive patients. Int J Cardiol 2017; 228:401-405. [DOI: 10.1016/j.ijcard.2016.11.243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/07/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
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Nedios S, Sommer P, Bollmann A, Hindricks G. Advanced Mapping Systems To Guide Atrial Fibrillation Ablation: Electrical Information That Matters. J Atr Fibrillation 2016; 8:1337. [PMID: 27909489 PMCID: PMC5089464 DOI: 10.4022/jafib.1337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 02/17/2016] [Accepted: 04/29/2016] [Indexed: 12/25/2022]
Abstract
Catheter ablation is an established and widespread treatment for atrial fibrillation (AF). Contemporary electroanatomical mapping systems (EAMs) have been developed to facilitate mapping processes but remain limited by spatiotemporal and processing restrictions. Advanced mapping systems emerged from the need to better understand and ablate complex AF substrate, by improving the acquisition and illustration of electrophysiological information. In this review, we present you the recently advanced mapping systems for AF ablation in comparison to the established contemporary EAMs.
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Affiliation(s)
- Sotirios Nedios
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
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Bollmann A, Hilbert S, John S, Kosiuk J, Hindricks G. Initial Experience With Ultra High-Density Mapping of Human Right Atria. J Cardiovasc Electrophysiol 2015; 27:154-60. [PMID: 26456153 DOI: 10.1111/jce.12852] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 09/10/2015] [Accepted: 09/22/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recently, an automatic, high-resolution mapping system has been presented to accurately and quickly identify right atrial geometry and activation patterns in animals, but human data are lacking. This study aims to assess the clinical feasibility and accuracy of high-density electroanatomical mapping of various RA arrhythmias. METHODS AND RESULTS Electroanatomical maps of the RA (35 partial and 24 complete) were created in 23 patients using a novel mini-basket catheter with 64 electrodes and automatic electrogram annotation. Median acquisition time was 6:43 minutes (0:39-23:05 minutes) with shorter times for partial (4.03 ± 4.13 minutes) than for complete maps (9.41 ± 4.92 minutes). During mapping 3,236 (710-16,306) data points were automatically annotated without manual correction. Maps obtained during sinus rhythm created geometry consistent with CT imaging and demonstrated activation originating at the middle to superior crista terminalis, while maps during CS pacing showed right atrial activation beginning at the infero-septal region. Activation patterns were consistent with cavotricuspid isthmus-dependent atrial flutter (n = 4), complex reentry tachycardia (n = 1), or ectopic atrial tachycardia (n = 2). His bundle and fractionated potentials in the slow pathway region were automatically detected in all patients. Ablation of the cavotricuspid isthmus (n = 9), the atrio-ventricular node (n = 2), atrial ectopy (n = 2), and the slow pathway (n = 3) was successfully and safely performed. CONCLUSIONS RA mapping with this automatic high-density mapping system is fast, feasible, and safe. It is possible to reproducibly identify propagation of atrial activation during sinus rhythm, various tachycardias, and also complex reentrant arrhythmias.
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Affiliation(s)
- Andreas Bollmann
- Department of Electrophysiology, Heart Center, Leipzig, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center, Leipzig, Leipzig, Germany
| | - Silke John
- Department of Electrophysiology, Heart Center, Leipzig, Leipzig, Germany
| | - Jedrzej Kosiuk
- Department of Electrophysiology, Heart Center, Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, Leipzig, Leipzig, Germany
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