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Dittrich S, Scheurlen C, van den Bruck JH, Filipovic K, Wörmann J, Erlhöfer S, Schipper JH, Lüker J, Steven D, Sultan A. The omnipolar mapping technology-a new mapping tool to overcome "bipolar blindness" resulting in true high-density maps. J Interv Card Electrophysiol 2024; 67:399-408. [PMID: 37227537 PMCID: PMC10901967 DOI: 10.1007/s10840-023-01562-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Omnipolar mapping (OT) is a novel tool to acquire omnipolar signals for electro-anatomical mapping, displaying true voltage and real-time wavefront direction and speed independent of catheter orientation. The aim was to analyze previously performed left atrial (LA) and left ventricular (LV) maps for differences using automated OT vs. standard bipolar settings (SD) and HD wave (HDW) algorithm. METHODS Previously obtained SD and HDW maps of the LA and LV using a 16-electrode, grid-shaped catheter were retrospectively analyzed by applying automated OT, comparing voltage, point density, pulmonary vein (PV) gaps, and LV scar area. RESULTS In this analysis, 135 maps of 45 consecutive patients (30 treated for LA, 15 for LV arrhythmia) were included. Atrial maps revealed significantly higher point densities using OT (21471) vs. SD (6682) or HDW (12189, p < 0.001). Mean voltage was significantly higher using OT (0.75 mV) vs. SD (0.61 mV) or HDW (0.64 mV, p < 0.001). OT maps detected significantly more PV gaps per patient vs. SD (4 vs. 2), p = 0.001. In LV maps, OT revealed significantly higher point densities (25951) vs. SD (8582) and HDW (17071), p < 0.001. Mean voltage was significantly higher for OT (1.49 mV) vs. SD (1.19 mV) and HDW (1.2 mV), p < 0.001. Detected scar area was significantly smaller using OT (25.3%) vs. SD (33.9%, p < 0.001). CONCLUSION OT mapping leads to significantly different substrate display, map density, voltage, detection of PV gaps, and scar size, compared to SD and HDW in LA and LV procedures. Successful CA might be facilitated due to true HD maps.
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Affiliation(s)
- Sebastian Dittrich
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany.
| | - Cornelia Scheurlen
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany
| | | | - Karlo Filipovic
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany
| | - Jonas Wörmann
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany
| | - Susanne Erlhöfer
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany
| | - Jan-Hendrik Schipper
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany
| | - Jakob Lüker
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany
| | - Daniel Steven
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany
| | - Arian Sultan
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany
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Piorkowski C, Kronborg M, Hourdain J, Piorkowski J, Kirstein B, Neudeck S, Wechselberger S, Päßler E, Löwen A, El-Armouche A, Mayer J, Ulbrich S, Pu L, Richter U, Gaspar T, Huo Y. Endo-/Epicardial Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2018; 11:e005748. [DOI: 10.1161/circep.117.005748] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 12/12/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Christopher Piorkowski
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Mads Kronborg
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Jerome Hourdain
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Judith Piorkowski
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Bettina Kirstein
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Sebastian Neudeck
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Simon Wechselberger
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Ellen Päßler
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Anastasia Löwen
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Ali El-Armouche
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Julia Mayer
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Stefan Ulbrich
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Liying Pu
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Utz Richter
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Thomas Gaspar
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Yan Huo
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
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Szilágyi J, Marcus GM, Badhwar N, Lee BK, Lee RJ, Vedantham V, Tseng ZH, Walters T, Scheinman M, Olgin J, Gerstenfeld EP. Atrial fibrillation patients with isolated pulmonary veins: Is sinus rhythm achievable? J Cardiovasc Electrophysiol 2017; 28:754-761. [PMID: 28429499 DOI: 10.1111/jce.13230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/01/2017] [Accepted: 04/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The cornerstone of atrial fibrillation (AF) ablation is isolation of the pulmonary veins (PVs). Patients with recurrent AF undergoing repeat ablation usually have PV reconnection (PVr). The ablation strategy and outcome of patients undergoing repeat ablation who have persistent isolation of all PVs (PVi) at the time of repeat ablation is unknown. METHODS AND RESULTS We studied consecutive patients with recurrent AF undergoing repeat ablation and compared patients with PVi to those with PVr. One hundred fifty-two patients underwent repeat ablation, and of these, 25 patients (16.4%) had PVi. Patients with PVi underwent ablation targeting any isoproterenol induced AF triggers, atrial substrate, or inducible atrial tachycardias or flutters. Patients with PVi compared to PVr were more likely to have a history of persistent AF (64% vs. 26%; P < 0.0001), obesity (BMI 30.4 vs. 28.2; P = 0.05), and prior use of contact force sensing catheters (28% vs. 0.8%, P < 0.0001). After a mean follow-up of 19 ± 15 months, 56% of PVi patients remained in sinus rhythm compared to 76.3% of PVr patients (P = 0.036). In a multivariable model, PVi patients and those with cardiomyopathy had a higher risk of recurrent atrial tachyarrhythmias (HR = 3.6 95%, CI 1.6-8.3, P = 0.002 and HR = 6.2, 95% CI 2.3-16.3, P < 0.0001, respectively). CONCLUSION In patients who have all PVs isolated at the time of the redo AF ablation, a strategy of targeting non-PV AF triggers and inducible flutters can still lead to AF freedom in more than half of patients. Patients with PVr, however, have a better long-term outcome.
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Affiliation(s)
- Judit Szilágyi
- Section of Cardiac Electrophysiology and Arrhythmia Service, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Gregory M Marcus
- Section of Cardiac Electrophysiology and Arrhythmia Service, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Nitish Badhwar
- Section of Cardiac Electrophysiology and Arrhythmia Service, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Byron K Lee
- Section of Cardiac Electrophysiology and Arrhythmia Service, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Randall J Lee
- Section of Cardiac Electrophysiology and Arrhythmia Service, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Vasanth Vedantham
- Section of Cardiac Electrophysiology and Arrhythmia Service, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Zian H Tseng
- Section of Cardiac Electrophysiology and Arrhythmia Service, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Tomos Walters
- Section of Cardiac Electrophysiology and Arrhythmia Service, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Melvin Scheinman
- Section of Cardiac Electrophysiology and Arrhythmia Service, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Jeffrey Olgin
- Section of Cardiac Electrophysiology and Arrhythmia Service, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology and Arrhythmia Service, Division of Cardiology, University of California, San Francisco, CA, USA
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