scholarly journals High-density mapping to guide ablation of a right bundle branch morphology premature ventricular contraction from the right outflow tract

2018 ◽  
Vol 6 (6) ◽  
pp. 1060-1065
Author(s):  
Antonio De Simone ◽  
Vincenzo La Rocca ◽  
Alfonso Panella ◽  
Valter Bianchi ◽  
Francesco Maddaluno ◽  
...  
Keyword(s):  
Premature Ventricular Contraction ◽  
Outflow Tract ◽  
High Density ◽  
Ventricular Contraction ◽  
Density Mapping ◽  
The Right ◽  
Branch Morphology

P957Characteristics of atrial tachycardia after mitral surgey via biatrial trans-septal approach using high density mapping system

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Cataldi ◽  
M Andronache ◽  
R Eschalier ◽  
F Jean ◽  
R Bosle ◽  
...  
Keyword(s):  
Atrial Tachycardia ◽  
Sinus Node ◽  
Pulmonary Veins ◽  
High Density ◽  
Congenital Defects ◽  
Density Mapping ◽  
Mapping System ◽  
Oblique Incision ◽  
Pace Maker ◽  
The Right

Abstract Background The biatrial trans-septal approach (BTSa) ameliorates mitral valve (MV) exposure in difficult cases when routine left atriotomy doesnt"t allow it. Main steps are an oblique incision on the right atrium (RA), reaching medially the right pulmonary veins (PV), a septal incision from the fossa ovalis, extended up to reach the first incision, then on the left atrium (LA). Purpose We aim to study the arrhythmic burden in this post-surgical context, focusing on atrial tachycardia (AT), to investigate the complexity of several possible circuits. Methods All patients (>18yo) with previous MV surgery via BTSa for MV repair or replacement, who underwent ablation of AT from January 2017 to September 2019, were enrolled. Patients ablated for persistent or paroxysmal AF, or with AF during the index procedure were excluded. Patients with associated surgery on other valves or congenital defects, coronary, surgical or percutaneous rhythm interventions weren’t excluded. Electroanatomical mapping was created using 2 different high-density mapping system. Substrate and activation map and radio-frequency (RF) ablation (25-50W, Ablation Index target 400) were realized. Cartographies were analysed to evaluate AT re-entry circuit, critical isthmus (CI) location and characterization, atrial vulnerability. Procedural outcomes (AT termination, sinus rhythm (SR) restoration, anti-arrhythmic drugs (AAD) withdrawal), and peri-procedural complications were also evaluated. Results We enrolled 49 patients (median age 57 ± 15), finding a maximum of 5 AT per procedure (2 ± 1). A total of 112 AT were mapped: the majority (72%) were persistent AT, 8,2% common atrial flutter. Cycle length was 314 ± 74 msec, with proximal-distal activation of coronary sinus (78%). A multiple re-entry circuit was observed in 70% of index AT. We identified 152 critical isthmus (maximum 5 per procedure). Only 27,9% of our patients had a single CI; CTI was the most frequent one (n = 37), envolved in 33% of all AT, while BTS scars altogether were envolved in 65% AT. A complete AT circuit was mapped in the RA, the LA and both atria in respectively 49%, 11,5% and 39%AT. The distribution of CIs is shown in figure 1. Biatrial and left AT leads to superior procedure, RF and fluoroscopy duration (p <0,05). SR was restored in 93,4%of patients, requiring a DC shock in 4 cases. Immediate AAD withdrawal was achieved after 41%procedures. No pericardial, oesophageal, vascular or phrenic complication occurred. 4 pace-maker implantations were realized because of 3 interatrial, 2 AV block and a sinus node dysfunction. Conclusions AT occurring after a BTSa have a high prevalence of multiple re-entry circuits with multiple critical isthmus. Ablation in this context is feasible and safe but often requires a left atrial access. Mapping of both atria should be considered to identify critical isthmus and tailored ablation strategy. Abstract Figure 1. Critical Isthmus Distribution

scholarly journals Bipolar ablation with half normal saline for deep intramural outflow tract premature ventricular contraction

2019 ◽  
Vol 5 (8) ◽  
pp. 436-439 ◽  
Author(s):  
Andres Enriquez ◽  
Victor Neira ◽  
David Bakker ◽  
Jason Baley ◽  
Gianluigi Bisleri ◽  
...  
Keyword(s):  
Normal Saline ◽  
Premature Ventricular Contraction ◽  
Outflow Tract ◽  
Ventricular Contraction ◽  
Bipolar Ablation

Outcome after practical isthmus ablation of scar-related atrial tachycardia guided by high-density mapping

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Jungen ◽  
R Akbulak ◽  
A Kahle ◽  
C Eickholt ◽  
B Schaeffer ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Atrial Tachycardia ◽  
Outcome Data ◽  
High Density ◽  
Density Mapping ◽  
Number Of Patients ◽  
Basket Catheter ◽  
Acute Success ◽  
The Right ◽  
Mean Cycle

Abstract Background High-density mapping (HDM) has been found to precisely identify the practical isthmus of scar-related atrial tachycardia (AT) circuits. Since practical isthmuses have been found to be shorter than the usual anatomical isthmuses targeted ablation has been proposed. However, outcome data are sparse. Here we describe HDM-guided catheter ablation by targeting the practical isthmus in patients with scar-related ATs. Methods and results In 250 consecutive patients with scar-related ATs HDM-guided catheter ablation with the support of a 64-electrode mini-basket catheter has been performed. Most patients underwent a prior catheter ablation (98%) while 13% had a prior cardiac valve surgery and 6% an underlying congenital heart disease. A total of 355 ATs occurred in the index procedure, of which 64% had a macro-, 26% a micro-reentry and 10% a focal mechanism. The ATs had a mean cycle length of 304±4.3 ms and in 237 patients (95%) an acute termination into sinus rhythm was achieved. They were mainly located in the left atrium (72%) but also in the right atrium (25%), bi-atrially (5%) or in the CS (3%) (see figure). Targeting the practical isthmus revealed arrhythmia freedom in 53% of patients after a single procedure during a mid-term follow-up (median 489 days, range 95–1407 days). Freedom from any arrhythmia could be achieved in 74% of patients after multiple procedures and in 93% of patients after multiple procedures and optimal clinical therapy, including pharmaceutical or electrical cardioversion. Conclusions HDM-guided catheter ablation of the practical isthmus in patients with scar-related ATs leads to a high acute success rate. Nevertheless, multiple procedures are necessary in a relevant number of patients resulting in a low recurrence rate. Funding Acknowledgement Type of funding source: None

scholarly journals Recording Intrinsic Nerve Activity at the Sinoatrial Node in Normal Dogs with High-density Mapping

2021 ◽  
Author(s):  
Yufan Yang ◽  
Yuan Yuan ◽  
Johnson Wong ◽  
Michael C. Fishbein ◽  
Peng-Sheng Chen ◽  
...  
Keyword(s):  
Heart Rate ◽  
Sinoatrial Node ◽  
Stellate Ganglion ◽  
High Density ◽  
Nerve Activity ◽  
Density Mapping ◽  
Sinus Rate ◽  
Intrinsic Nerve ◽  
The Right ◽  
Stimulation Of

Background - It is known that autonomic nerve activity controls the sinus rate. However, the coupling between local nerve activity and electrical activation at the sinoatrial node (SAN) remains unclear. We hypothesized that we would be able to record nerve activity at the SAN to investigate if right stellate ganglion (RSG) activation can increase the local intrinsic nerve activity, accelerate sinus rate, and change the earliest activation sites (EASs). Methods - High-density mapping of the epicardial surface of the right atrium (RA) including the SAN was performed in 6 dogs during stimulation of the RSG, and after RSG stellectomy. A radiotransmitter was implanted into 3 additional dogs to record RSG and local nerve activity at the SAN. Results - Heart rate accelerated from 108±4 bpm at baseline to 125±7 bpm after RSG stimulation ( P =0.001), and to 132±7 bpm after apamin injection ( P <0.001). Both electrical RSG stimulation and apamin injection induced local nerve activity at the SAN with the average amplitudes of 3.60±0.72 µV and 3.86±0.56 µV, respectively. RSG stellectomy eliminated the local nerve activity and decreased the heart rate. In ambulatory dogs, local nerve activity at the SAN had a significantly higher average Pearson correlation to heart rate (0.72±0.02, P =0.001) than RSG nerve activity to HR (0.45±0.04 P =0.001). Conclusions - Local intrinsic nerve activity can be recorded at the SAN. Short bursts of these local nerve activities are present before each atrial activation during heart rate acceleration induced by stimulation of the right stellate ganglion.

scholarly journals Electroanatomical high-density mapping of different tachycardias in the right atrium after heart transplantation

2016 ◽  
Vol 2 (6) ◽  
pp. 517-520 ◽  
Author(s):  
Alexandra Schratter ◽  
Valentina Schirripa ◽  
Jedrzej Kosiuk ◽  
Emmanuel Koutalas ◽  
Gerhard Hindricks ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Right Atrium ◽  
High Density ◽  
Density Mapping ◽  
The Right
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