1
|
Luani B, Rauwolf T, Genz C, Schmeißer A, Wiemer M, Braun-Dullaeus RC. Intracardiac echocardiography versus fluoroscopy for endovascular and endocardial catheter navigation during cryo-ablation of the slow pathway in AVNRT patients. Cardiovasc Ultrasound 2019; 17:12. [PMID: 31186001 PMCID: PMC6560740 DOI: 10.1186/s12947-019-0162-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
Background A new zero-fluoroscopy technique for electrophysiology catheter navigation relying on intracardiac echocardiography (ICE) has been recently reported (Ice&ICE trial). We investigated potential differences in efficacy, safety or procedural performance between conventional fluoroscopy- and ICE-guided cryothermal ablation (CA) in symptomatic AVNRT patients. Methods Clinical and electrophysiological data of AVNRT patients included in the Ice&ICE trial (22 patients, 16 females; =zero-fluoroscopy group) were compared to those of consecutive AVNRT patients, who underwent fluoroscopy-guided CA (25 patients, 17 females; = fluoroscopy group) during the last 2 years in our institution. Results Slow pathway ablation or modulation was successful in all patients. Fluoroscopy time and radiation dose in the fluoroscopy group were 11.2 ± 9.0 min and 20.3 ± 16.2Gycm2, whereas no fluoroscopy was used in the opposite group (p < 0.001, respectively). EPS duration was not different between the groups (zero-fluoroscopy:101.6 ± 40.2 min, fluoroscopy:99.4 ± 37.2 min, p = n.s.). Catheter placement time was significantly shorter in the fluoroscopy group (2.2 ± 1.6 min vs. 12.0 ± 7.5 min, p < 0.05), whereas cryo-application duration (from the first cryo-mapping to the last CA) was significantly shorter in the zero-fluoroscopy group (27.5 ± 37.0 min vs. 38.1 ± 33.9 min, p < 0.05). Mean cryo-mapping and CA applications were numerically lower in the zero-fluoroscopy group (CM:7.5 ± 5.7 vs. 8.8 ± 6.2; CA:3.1 ± 1.7 vs. 3.2 ± 2.0, p = n.s.). No major adverse events occurred in both groups. After 15.0 ± 4.2 months, arrhythmia recurrence was not different between the groups (4.5% vs. 8.0%, p = n.s.). Conclusions Zero-fluoroscopy ICE-guided EP catheter navigation shows comparable efficacy and safety to fluoroscopic guidance during CA in AVNRT patients. ICE visualization of catheters and endocardial structures within the triangle of Koch shortens the cryo-application duration, though time needed for catheter placement is longer, when compared with conventional fluoroscopic guidance, which results in similar mean EPS duration with both navigation techniques. Trial registration (German Clinical Trials Register ID: DRKS00011360; Registration Date 14.12.2016) Electronic supplementary material The online version of this article (10.1186/s12947-019-0162-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Blerim Luani
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Str. 1, 32429, Minden, Germany.
| | - Thomas Rauwolf
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Conrad Genz
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Alexander Schmeißer
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Marcus Wiemer
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Str. 1, 32429, Minden, Germany
| | - Rüdiger C Braun-Dullaeus
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| |
Collapse
|
2
|
Álvarez A. Capítulo 2. Utilidad del mapeo tridimensional en pacientes con taquicardia nodal y taquicardias mediadas por vías anómalas. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
3
|
Anatomical and electrophysiological variations of Koch's triangle and the impact on the slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia: a study using 3D mapping. J Interv Card Electrophysiol 2013; 37:111-20. [PMID: 23408048 DOI: 10.1007/s10840-012-9769-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aimed to reveal individual variations in Koch's triangle using NavX and to evaluate the efficacy of the NavX-guided slow pathway ablation. METHODS A regional geometry around Koch's triangle was constructed in 42 consecutive patients with atrioventricular nodal reentrant tachycardia (AVNRT), and a bipolar electrogram map was created with 72 ± 30 sampling points during sinus rhythm to identify sites with Haissaguerre's slow potentials (SPs) and His bundle electrograms (HBEs) to examine the anatomical and electrical variations. Radiofrequency ablation was performed at the most prominent SP recording site. The acute results and long-term outcome were examined in comparison to another 42 consecutive patients who underwent a conventional fluoroscopy-guided slow pathway ablation in the previous months. RESULTS The size of Koch's triangle and the coronary sinus ostium varied over a wide range of 132 to 490 and 69 to 346 mm(2), respectively. HBEs were recorded linearly along the antero-septal right atrium (n = 29) or deviated downward toward the midseptum (n = 13, 31 %). The SPs were always distributed below the lowest HBE recording site. The NavX-guided ablation eliminated AVNRT with a median of 1 radiofrequency pulse, 9.1 ± 4.6 min of fluoroscopy, and 49 ± 14 min of procedure time, all of which were significantly smaller than those in fluoroscopy-guided ablation. No procedure-related complications or long-term recurrence was noted in either group. CONCLUSION Koch's triangle varies in terms of the size and electrogram distribution, and the NavX-guided slow pathway ablation overcomes the diversity and seems more effective than fluoroscopy-guided ablation.
Collapse
|
4
|
Tanaka S, Yoshida A, Fukuzawa K, Takei A, Kanda G, Takami K, Kumagai H, Takami M, Itoh M, Imamura K, Fujiwara R, Hirata KI. Recognition of inferiorly dislocated fast pathways guided by three-dimensional electro-anatomical mapping. J Interv Card Electrophysiol 2011; 32:95-103. [DOI: 10.1007/s10840-011-9595-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 06/01/2011] [Indexed: 11/25/2022]
|
5
|
Pua EC, Idriss SF, Wolf PD, Smith SW. Real-time three-dimensional transesophageal echocardiography for guiding interventional electrophysiology: feasibility study. ULTRASONIC IMAGING 2007; 29:182-194. [PMID: 18092674 DOI: 10.1177/016173460702900304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
At present, there are limited methods of acquiring three-dimensional visualization of cardiac structure and function in real-time during interventional electrophysiology procedures. Images acquired for integration of computerized tomography and magnetic resonance imaging with electroanatomic mapping systems are static and are obtained earlier in time. The purpose of this study was to test the feasibility of real-time three-dimensional transesophageal echocardiography for the guidance of interventional electrophysiological studies. A matrix array transducer with 504 channels operating at 5 MHz in a 1 cm diameter steerable esophageal probe was used in conjunction with a scanner capable of real-time 3D scanning of pyramidal volumes from 65 degrees to 120 degrees at rates up to 30 volumes per second. This device has a spatial resolution of approximately 3 mm at 5 cm depth. The authors acquired real-time three-dimensional images of anatomic landmarks of value for electrophysiological procedures in five closed chest canines. Real-time, three-dimensional ultrasound imaging was also used for visualization and guidance of interventional catheter devices within the canine heart. Real-time three-dimensional images of the atria, pulmonary veins, and coronary sinus were acquired. Real-time 3-D color flow Doppler was employed to confirm patency. Multiple image planes of image volumes and rendered views were used to track catheter position and orientation. Images of left veno-atrial junctions have been confirmed by dissection. This study has demonstrated the feasiblity of using real-time three-dimensional transesophageal echocardiography for guiding interventional electrophysiology. The technology has the potential to fill a niche as an adjunct modality for cost-effective real-time interventional guidance and assessment, providing catheter and pacing lead visualization simultaneously with functional volumetric cardiac imaging.
Collapse
Affiliation(s)
- Eric C Pua
- Department of Mechanical Engineering and Materials Science, Duke University, Box 90300, Durham, NC 27708, USA.
| | | | | | | |
Collapse
|
6
|
Tuzcu V. A Nonfluoroscopic Approach for Electrophysiology and Catheter Ablation Procedures Using a Three-Dimensional Navigation System. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:519-25. [PMID: 17437576 DOI: 10.1111/j.1540-8159.2007.00702.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Three-dimensional (3D) electroanatomical navigation systems decrease the fluoroscopy time of electrophysiology and ablation procedures. The aim of this study was to assess the safety and efficacy of a complete nonfluoroscopic approach for electrophysiologic studies and right-sided catheter ablations for supraventricular tachycardia in patients with normal cardiac anatomy using a 3D, surface electrode-based navigation system (NavX, St. Jude Medical, St. Paul, MN, USA). METHODS AND RESULTS Electrophysiologic studies were performed in 26 consecutive cases (12.7 +/- 7.5 years) using NavX without fluoroscopy. The procedure time was 98.7 +/- 49.7 minutes. Nonfluoroscopic catheter ablations were performed in 24 of 28 consecutive patients. Cryoablation was used in 23 of 24. The procedure time was 193.5 +/- 80 minutes. The coronary sinus access was obtained in 32.1 +/- 12 (range: 15-60) seconds. No complications occurred. All patients (n = 19) who underwent cryoablation for right-sided arrhythmia substrates with conventional fluoroscopic guidance in addition to NavX were used as a control group (10.1 +/- 5.2 years). Catheter ablation success rate of the control group (16/19, 84%) was not significantly different compared to the patients who underwent ablation without fluoroscopy (22/24, 92%). The procedure time was also not significantly different between the two groups (P = NS). CONCLUSION This study demonstrates that nonfluoroscopic electrophysiologic studies and right-sided catheter ablations for supraventricular tachycardia can be safely and effectively performed in the majority of patients with normal cardiac anatomy using NavX. Further studies will be necessary in order to establish the potential utility of NavX in eliminating or decreasing radiation exposure for other electrophysiology procedures.
Collapse
Affiliation(s)
- Volkan Tuzcu
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202, USA
| |
Collapse
|
7
|
Gimbel JR. A streamlined, anchored, anatomical approach to ablation of atrioventricular nodal reentry tachycardia: preliminary report of the first 25 cases. J Interv Card Electrophysiol 2005; 12:143-8. [PMID: 15744467 DOI: 10.1007/s10840-005-6550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 12/09/2004] [Indexed: 10/25/2022]
Abstract
UNLABELLED A pseudo r' in V1 during supraventricular tachycardia (SVT), but not during sinus rhythm is pathognomonic for AV nodal re-entry tachycardia (AVNRT). During radiofrequency (RF) energy delivery, stability of the catheter tip is crucial. Intra-procedural catheter and patient movement as well as abrupt rhythm changes can lower efficacy, prolong procedural time, and contribute to the risk of AV block. OBJECTIVES A novel streamlined approach using a single sheath and two catheters was evaluated that leverages the patient's own anatomy to help stabilize catheter position during RF application and localize RF targets. METHODS Twenty-five consecutive patients presenting with documented SVT were ablated using a single sheath technique with only two catheters. A 12F 75 cm sheath was inserted via the right femoral vein and its tip is placed at base of the right atrium (RA). Through this sheath a 6F coronary sinus (CS) catheter and 6F ablation catheter are placed. After confirming the diagnosis of AVNRT, the ablation catheter tip is positioned anterior to the CS os in the slow pathway region. During RF application, the mobility constraints of the "sheath-catheter-catheter" complex provide excellent electrogram and catheter stability by taking advantage of the "collaring" effect of the sheath which is in turn "anchored" to the diagnostic CS catheter. RESULTS Acute procedural success was 100% with no apparent complications. Flouroscopy time was modest (8.5 min (range 3.1-22)) as were the case times (mean 120 min (range 52-206)). Cost savings compared to "3 cath-3 sheath" approach was 113 U.S. dollars and would be much larger if compared to newer non-flouroscopic navigational systems or using alternative ablation energy sources. CONCLUSIONS This new approach minimizes ablation catheter tip movement on the slow pathway region providing a safe, successful, speedy, and economical alternative to a traditional 3 or 4 catheter approach in appropriately selected SVT patients.
Collapse
|
8
|
Kanter RJ. Pace mapping the fast pathway in patients with atrioventricular nodal reentrant tachycardia: Koch's triangle or the Bermuda Triangle? J Cardiovasc Electrophysiol 2005; 16:36-8. [PMID: 15673384 DOI: 10.1046/j.1540-8167.2005.04753.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
9
|
Sporton SC, Earley MJ, Nathan AW, Schilling RJ. Electroanatomic Versus Fluoroscopic Mapping for Catheter Ablation Procedures:. J Cardiovasc Electrophysiol 2004; 15:310-5. [PMID: 15030422 DOI: 10.1111/j.1540-8167.2004.03356.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this prospective randomized study was to compare the routine use of electroanatomic imaging (CARTO) with that of conventional fluoroscopically guided activation mapping (conventional) in an unselected population referred for catheter ablation. We sought to compare the two approaches with respect to procedure outcome and duration, radiation exposure, and cost. METHODS AND RESULTS All patients undergoing catheter ablation (with the exception of complete AV nodal ablation) were prospectively randomized to either a CARTO or conventional procedure for mapping and ablation. One hundred two patients were randomized. Acute procedural success was similar with either strategy (CARTO vs conventional 43/47 vs 51/55, P > 0.5), as was procedure duration (144 [58] vs 125 [48] min, P = 0.07 (mean [SD]). CARTO was associated with a substantial reduction in fluoroscopy time (9.3 [7.6] vs 28.8 [19.5] min, P < 0.001) and radiation dose (6.2 [6.1] vs 20.8 [32.7] Gray, P = 0.003). CARTO cases used fewer catheters (2.5 [0.7] vs 4.4 [1.1], P < 0.001), but catheter costs were higher (13.8 vs 9.3 units, P < 0.001, where one unit is equivalent to the cost of a nonsteerable quadripolar catheter). CONCLUSION For all catheter ablation procedures, even when a center's "learning curve" for CARTO is included, procedure duration and outcome are similar for CARTO and conventional procedures. CARTO is associated with drastically reduced fluoroscopy time and radiation dose. Although fewer catheters are used with CARTO, catheter costs remain higher.
Collapse
Affiliation(s)
- Simon C Sporton
- Department of Cardiology, Bart's and The London NHS Trust, London, United Kingdom
| | | | | | | |
Collapse
|
10
|
Abstract
Assessment of the timing of electrical activation recorded by multiple electrodes positioned in various locations within the heart has been the conventional method for mapping cardiac arrhythmias. This technique requires fluoroscopy for catheter manipulation, which in addition to being harmful (ionizing radiation), is inadequate for visualizing the complex three-dimensional cardiac anatomy and lacks reproducibility regarding localization of sites of interest. Because of these limitations, several new mapping systems that can function in a complimentary role to the conventional mapping technique, or can be used independently, have been developed. These new mapping strategies have unique advantages. They overcome the limitations of fluoroscopy by creating accurate three-dimensional intracardiac maps. The ability to localize and accurately display intracardiac catheter positioning and ablation lesion sites facilitate increasingly complex catheter ablation procedures.
Collapse
Affiliation(s)
- Sanjay Dixit
- Section of Cardiac Electrophysiology, Hospital of The University of Pennsylvania, Philadelphia 19104, USA
| | | |
Collapse
|
11
|
Coyne RF, Deely M, Gottlieb CD, Marchlinski FE, Callans DJ. Electroanatomic magnetic mapping during ablation of isthmus-dependent atrial flutter. J Interv Card Electrophysiol 2000; 4:635-43. [PMID: 11141211 DOI: 10.1023/a:1026582002762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Although recent studies have demonstrated that the endpoint of isthmus conduction block is superior to that of termination and subsequent inability to induce atrial flutter (AFl), the optimal method for determining isthmus conduction block has not been determined. Electroanatomic magnetic mapping during coronary sinus (CS) pacing may provide a reliable endpoint for AFl ablation. METHODS AND RESULTS Catheter mapping and ablation was performed in 42 patients with isthmus-dependent AFl. The patients were divided into two groups, based on procedural endpoint: Group I (28 patients) - isthmus conduction block was determined based on multipolar catheter recordings and electroanatomic mapping, and Group II (14 patients) - isthmus conduction block was determined by electroanatomic mapping during CS pacing alone. In Group I, ablation procedures were acutely successful in 25 of 28 patients (89 %). A 100 % concordance between the data presented by multipolar catheter recordings and electroanatomic mapping was noted in determining the presence or absence of isthmus conduction block. In Group II, ablation procedures were acutely successful in 13 of 14 patients, 13 (93 %). After a mean of 16.3+/-3.7 months follow up, there was 1 atrial flutter recurrence in the 38 patients (2.6 %) with demonstrated isthmus block at the end of the procedure. CONCLUSIONS Electroanatomic magnetic mapping during CS pacing is comparable to the multipolar catheter mapping technique for assessing isthmus conduction block as an endpoint for AFl ablation procedures.
Collapse
Affiliation(s)
- R F Coyne
- Clinical Electrophysiology Laboratories of the Allegheny University Hospitals, MCP Division, Philadelphia, PA, USA
| | | | | | | | | |
Collapse
|
12
|
Abstract
Electromechanical endocardial mapping of the heart using a nonfluoroscopic catheter-based system is a new imaging modality that has been studied recently in the experimental setting as well as in patients. Besides its original application in the diagnosis and treatment of various cardiac arrhythmias, it has also been used as an investigational tool for assessing left ventricular function and viability. Finally, the mapping system may be a valuable platform for direct myocardial revascularization using either laser treatment or injection of pharmacologic agents.
Collapse
Affiliation(s)
- K C Koch
- Medizinische Klinik I, Department of Cardiology, University Hospital, RWTH, Aachen, Germany
| | | |
Collapse
|
13
|
Friedman PA, Packer DL, Hammill SC. Catheter ablation of mitral isthmus ventricular tachycardia using electroanatomically guided linear lesions. J Cardiovasc Electrophysiol 2000; 11:466-71. [PMID: 10809501 DOI: 10.1111/j.1540-8167.2000.tb00343.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Mitral isthmus ventricular tachycardia uses a reentrant circuit with a critical isthmus of conduction bounded by the mitral valve proximally and a remote inferior infarction scar distally. Successful catheter ablation requires placement of a lesion to transect the isthmus so as to prevent wavefront propagation. We report a case with previously unsuccessful ablation in which focal isthmus ablation failed to eliminate arrhythmia. Electroanatomic mapping demonstrated a wide tachycardia isthmus, and a linear lesion placed from the edge of the inferior infarct (as demonstrated on the three-dimensional voltage electroanatomic map) to the base of the mitral valve successfully eliminated tachycardia. In some patients with mitral isthmus VT, a wide isthmus requires linear lesion placement to fully transect the isthmus and eliminate tachycardia. Electroanatomic mapping can be used to define isthmus boundaries and thus guide successful ablation.
Collapse
Affiliation(s)
- P A Friedman
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
| | | | | |
Collapse
|
14
|
Goya M, Takahashi A, Nakagawa H, Iesaka Y. A case of catheter ablation of accessory atrioventricular connection between the right atrial appendage and right ventricle guided by a three-dimensional electroanatomic mapping system. J Cardiovasc Electrophysiol 1999; 10:1112-8. [PMID: 10466493 DOI: 10.1111/j.1540-8167.1999.tb00285.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 12-year-old girl was referred to our institution because of frequent episodes of AV reciprocating tachycardia. Ventriculoatrial and AV intervals were relatively long along the tricuspid annulus. Earliest retrograde atrial activation was recorded at the mid-portion of the right atrial appendage, 7 mm from the tricuspid annulus. The CARTO electroanatomic mapping system was very useful for providing accurate spatial orientation of the accessory connection. Complete ablation of this connection required multiple radiofrequency energy applications over an extensive area because of the multicomponent structure of the connection.
Collapse
Affiliation(s)
- M Goya
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan.
| | | | | | | |
Collapse
|
15
|
Wilber DJ, Kall JG, Cooke PA. Electroanatomic imaging using magnetic catheter tracking in the diagnosis and treatment of atrial arrhythmias. J Electrocardiol 1999; 31 Suppl:92-100. [PMID: 9988011 DOI: 10.1016/s0022-0736(98)90299-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Recent data emphasize the importance of structural factors in the pathophysiology of atrial arrhythmias. As a consequence, catheter ablation increasingly has become an anatomically oriented procedure. A recently developed magnetic catheter tracking system provides spatially precise and realistic three-dimensional reconstructions of endocardial geometry. A variety of electrophysiologic data can be superimposed on these reconstructions, including activation sequence, electrogram amplitude and morphologic features, response to pacing maneuvers, and sites of planned or delivered radiofrequency energy ablation. These features enhance the ability to analyze and visualize arrhythmia mechanisms, plan and execute appropriate ablation strategies, and provide new opportunities for physiologic research.
Collapse
Affiliation(s)
- D J Wilber
- Electrophysiology Laboratories, University of Chicago, Illinois, USA
| | | | | |
Collapse
|