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Zhang J. High density mapping of atrial tachycardia in patients post cardiac surgery. Pacing Clin Electrophysiol 2023; 46:1357-1365. [PMID: 37910563 DOI: 10.1111/pace.14858] [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: 07/01/2023] [Revised: 10/08/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
Mapping and ablation of atrial tachycardia (AT) in patients who have had prior cardiac surgery can be a challenge for clinical electrophysiologists. High density mapping (HDM) technology has been widely used in these patients because it provides a better characterization of the substrate and the mechanisms with an unprecedented high resolution. In this review, we summarize how the latest HDM technologies can reveal the mechanism of AT in different types of patients post-cardiac surgery and guide a specifically tailored ablation strategy.
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Affiliation(s)
- Jinlin Zhang
- Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, China
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Yavin HD, Sroubek J, Yarnitsky J, Bubar ZP, Higuchi K, Zilberman I, Basu S, Anter E. Direction-aware mapping algorithms have minimal impact on bipolar voltage maps created using high-resolution multielectrode catheters. J Cardiovasc Electrophysiol 2021; 33:73-80. [PMID: 34822200 DOI: 10.1111/jce.15299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/11/2021] [Accepted: 10/27/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Direction-aware mapping algorithms improve the accuracy of voltage mapping by measuring the maximal voltage amplitude recorded in the direction of wavefront propagation. While beneficial for stationary catheters, its utility for roving catheters collecting electrograms (EGMs) at multiple angles is unknown. OBJECTIVE To compare the directional dependence of bipolar voltage amplitude between stationary and roving catheters. METHODS In 10 swine, a transcaval ablation line with a gap was created. The gap was mapped using an array catheter (Optrell™; Biosense Webster). In Step 1, the array was kept stationary over the gap, and four voltage maps were created during activation of the gap from superior, inferior, septal, and lateral directions. In Step 2, four additional maps were created; however, the catheter was allowed to move with points acquired at multiple angles. In Step 3, the gap was remapped; however, bipoles were computed using a direction-aware mapping algorithm. RESULTS In a stationary catheter position, bipolar voltage distribution was influenced by the direction of activation with maximal differences obtained between orthogonal directions 32% (13%-53%). However, roving the catheter produced similar bipolar voltage maps irrespective of the direction of activation 11% (5%-18%). A direction-aware mapping algorithm was beneficial for reducing the directional dependence of voltage maps created by stationary catheters but not by roving catheters. CONCLUSION The directional dependency of bipolar voltage amplitude is greatest when the catheter is stationary. However, when the catheter is allowed to rove and collect EGMs at multiple angles as occurs clinically, the directional dependence of bipolar voltage is minimal.
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Affiliation(s)
- Hagai D Yavin
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Cardiovascular and Metabolic Sciences, Mark-Josephson and Andrew Wit Research Laboratory, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Cardiovascular and Metabolic Sciences, Mark-Josephson and Andrew Wit Research Laboratory, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Zachary P Bubar
- Department of Cardiovascular and Metabolic Sciences, Mark-Josephson and Andrew Wit Research Laboratory, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Biosense Webster of Johnson & Johnson, Irvine, California, USA
| | - Koji Higuchi
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Cardiovascular and Metabolic Sciences, Mark-Josephson and Andrew Wit Research Laboratory, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Israel Zilberman
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Cardiovascular and Metabolic Sciences, Mark-Josephson and Andrew Wit Research Laboratory, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shubhayu Basu
- Biosense Webster of Johnson & Johnson, Irvine, California, USA
| | - Elad Anter
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Cardiovascular and Metabolic Sciences, Mark-Josephson and Andrew Wit Research Laboratory, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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