scholarly journals Effective and fast characterization of a complex atrial flutter in patient with previous atrial surgery and ablation procedure: The importance of new ultra–high‐density mapping tools

2020 ◽  
Vol 8 (12) ◽  
pp. 3458-3462
Author(s):  
Giuseppe Mascia ◽  
Paolo Sartori ◽  
Italo Porto
Keyword(s):  
Atrial Flutter ◽  
High Density ◽  
Ablation Procedure ◽  
Density Mapping

scholarly journals P1386Typical atrial flutter circuit characterization using ultra-high density mapping

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii272-iii272
Author(s):  
SS. Bun ◽  
DG. Latcu ◽  
T. Delassi ◽  
A. Al Amoura ◽  
B. Enache ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
High Density ◽  
Density Mapping

231Local impedance-guided ablation and ultra-high density mapping provide improved ablation metrics vs conventional or contact force-guided ablation for cavotricuspid isthmus dependent atrial flutter

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Saraf ◽  
G M Morris
Keyword(s):  
Atrial Flutter ◽  
Contact Force ◽  
Cost Savings ◽  
High Density ◽  
Patient Specific ◽  
Procedure Time ◽  
Potential Cost ◽  
Cavotricuspid Isthmus ◽  
Density Mapping

Abstract INTRODUCTION. Radiofrequency ablation (RFA) of cavotricuspid isthmus dependent atrial flutter (CTI-AFL) can be performed with fluoroscopy (Fluo) or 3-dimensional (3D) electroanatomic mapping and contact force (CF) catheters. Local impedance (LI) is an alternative but no comparisons have yet been made. METHODS. An observational study comparing Fluo, CF- and LI-guided RFA for CTI-AFL. In the LI group, if CTI block was not obtained after initial ablation, ultra-high density mapping (UHDm) was used to identify breakthrough sites. Contact was determined using patient specific LI; RF delivered until 20 ohm LI drop seen, or LI drop plateaued >2 secs. In the CF group 10-40g force was used. Power was limited to 40-50W in all groups. Total RFA time, time from RFA start to CTI block, no. of lesions required to achieve block, acute success, complications and re-ablation during follow-up were analysed using ANOVA. RESULTS. Data presented for 24 patients (7 Fluo, 7 CF, 10 LI). Mean RFA time: 6.6, 5.9, 3.2 min respectively (p = 0.0478). Statistically significant differences also seen with LI vs Fluo (p = 0.0451) and LI vs CF (p = 0.0313). Time from first RFA to block: 25.5, 19.8, 14.2 min (p = 0.5688); number of lesions to achieve block: 8.5, 10.3, 8 (p = 0.3909). 100% success and no complications in all groups. 0% need for re-ablation (16.3 ± 7, 12.6 ± 8, 6.5 ± 4.4 months follow-up). DISCUSSION. This data illustrates that UHDm and LI-guidance significantly reduces the amount of CTI RFA, by 52% and 47% vs Fluo and CF respectively (p = sig, fig. 1). A reduction from first RFA to block is also seen (43% and 37%; p = ns, fig. 2). Given no difference in the no. of lesions, LI-guided RFA during lesion formation shortens the duration of each lesion. Many patients require further RFA (+/- mapping) if they do not achieve block following the initial ablation line, resulting in longer procedures. Several patients without block in the LI group underwent repeat UHDm, which quickly identified CTI or epicardial-endocardial breakthrough (fig. 3 & 4), allowing rapid targeting for re-ablation. In the fluo group, these procedures would often be significantly prolonged, meaning extensive RFA and radiation exposure. Fig. 1 shows smaller error bars with LI compared to the others, resulting in more predictable total ablation times; this could potentially benefit procedure scheduling (more procedures per unit time). We could not directly compare overall procedure time as many in the CF group had CTI RFA combined with left atrial RFA. Multiple LI cases were performed fluo-free with only magnetic tracking. This may allow case scheduling without a radiographer, with potential cost savings. CONCLUSION. LI-guided CTI-AFL RFA is safe and effective and has shown favourable ablation metrics compared to Fluo or CF-RFA. LI-RFA with UHDm more quickly and accurately identifies breakthrough and with fluoro-free technique could possibly reduce procedure time and cost. A larger study is planned to provide more insight. Abstract Figures

scholarly journals P926Preliminary experience of maximum voltage-guided approach with a novel ultra-high density mapping system for atrial flutter ablation

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii186-iii186
Author(s):  
G. Maglia ◽  
F. Arabia ◽  
V. Aspromonte ◽  
A. Mignano ◽  
M. Candigliota ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
High Density ◽  
Density Mapping ◽  
Mapping System ◽  
Maximum Voltage ◽  
Atrial Flutter Ablation

High-density versus low-density mapping in ablation of atypical atrial flutter

2021 ◽  
Author(s):  
J. C. Balt ◽  
M. N. Klaver ◽  
B. K. Mahmoodi ◽  
V. F. van Dijk ◽  
M. C. E. F. Wijffels ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
High Density ◽  
Low Density ◽  
Density Mapping

scholarly journals Influence of zones of low-amplitude activity on the mechanism and treatment of atrial arrhythmias.

2021 ◽  
Author(s):  
Elizaveta Dedukh ◽  
Elena Alexandrovna Artyukhina
Keyword(s):  
Atrial Flutter ◽  
Heart Surgery ◽  
Clinical Observation ◽  
High Density ◽  
Interventional Treatment ◽  
Atrial Arrhythmias ◽  
Density Mapping ◽  
Rf Exposure ◽  
Low Amplitude

Abstract: A clinical case of interventional treatment of a patient with atypical atrial flutter who has not previously undergone surgical or interventional heart surgery. This clinical observation demonstrates the role of common zones of low-amplitude activity on the mechanism and treatment of atrial arrhythmias. Widespread areas of low-amplitude activity in the left atrium can create barriers to the propagation of excitation, which can cause atypical atrial flutter. High density mapping will help visualize the mechanism of this arrhythmia. Understanding the mechanism of atypical atrial flutter will help minimize RF exposure during treatment. Key words: high density mapping; atypical atrial flutter; atrial fibrosis; radiofrequency ablation.

scholarly journals Successful case of complex atrial flutter occurring in a patient with congenitally corrected transposition of the great arteries, aberrant left atrial appendage, and situs inversus

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Feng Hu ◽  
Erpeng Liang ◽  
Lihui Zheng ◽  
Ligang Ding
Keyword(s):  
Atrial Flutter ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
High Density ◽  
Atrial Appendage ◽  
Transposition Of Great Arteries ◽  
Density Mapping ◽  
Successful Ablation ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition

Abstract Background Congenitally corrected transposition of great arteries (ccTGA) is a rare congenital cardiac defect with atrioventricular and ventriculoarterial discordance which leads to heart failure and limits patients’ lifespan. The extremely aberrant cardiac structure makes electrophysiological procedure and radiofrequency ablation very difficult to be performed in such patients. Until now, there were only sporadical cases that have reported the successful ablation of atrial flutter in ccTGA patients. Case presentation We report a case of a 36-year-old male who was diagnosed with dextrocardia, atrial septal defect and congenitally corrected transposition of great arteries (ccTGA) at a young age and received atrial septal defect repair and morphological tricuspid valve plasty in 2014. As for reasons of heart failure and atrial flutter, he frequently suffered from progressively worsening dyspnea and recurrent episodes of palpitations. Cardiac anatomic imaging reconstruction before electrophysiological test revealed an unusually huge left atrial appendage in this patient. After high-density mapping of both right atrium and left atrium, activation mapping showed reentry circuit loops were located in left atrium. Successful ablation strategy was performed under the guidance of high-density mapping and entrainment. Conclusion This is a clinical case showing high-density mapping and successful ablation of a complex dual-loop atrial flutter in a patient with ccTGA and aberrant left atrial appendage. The successful procedure corroborates clinical utility of high-density mapping approach in the treatment of the patients with complex congenital heart disease accompanied by rapid arrhythmia, can be simpler, safer and more effective.

High-density Mapping of the Human Sinus Node: The Effect of Atrial Remodelling Due to Atrial Flutter

2008 ◽  
Vol 17 ◽  
pp. S121
Author(s):  
Martin Stiles ◽  
Anthony Brooks ◽  
Bobby John ◽  
Dennis Lau ◽  
Hany Dimitri ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Sinus Node ◽  
High Density ◽  
Density Mapping ◽  
Atrial Remodelling

P441Targeted ablation of residual luminal pulmonary vein potentials through high density mapping: preliminary results from the CHARISMA registry

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
F Solimene ◽  
F M Cauti ◽  
G Zucchelli ◽  
V Schillaci ◽  
P Rossi ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
De Novo ◽  
Low Voltage ◽  
Complete Characterization ◽  
High Density ◽  
Analysis Tool ◽  
Temporal Consistency ◽  
Af Ablation ◽  
Density Mapping

Abstract Background A high incidence of pulmonary vein (PV) reconnection has been reported in patients (pts) with clinical recurrences of AF. Low-voltage activity beyond PVs (e.g. antral activity) may contribute to ablation failures in the long term. Detailed characterization of PV antra through high density mapping (HDM) and automated algorithm is still lacking.  Purpose to characterize PV gaps and the low-voltage activity in tissue such as the PV antra during and after ablation of PVs in AF pts.  Methods Consecutive pts undergoing AF ablation from the CHARISMA registry with complete characterization of residual PV antral activity were included. A complete map of the left atrium and PVs was performed prior and after ablation through the Rhythmia HDM system. A novel map analysis tool (Lumipoint - LM -) that automatically identifies split potentials and continuous activation was used sequentially on each PV component, in order to assess the presence of gaps (PVG) and residual potential within the antral scar (RAP, defined as any low voltage high frequency fractionated signal propagating within the antral scar without conduction into the vein) and characterize electrical propagation. After ablation we reassessed with repeat voltage and propagation maps that electrical quiescence was achieved. Ablation endpoint was PV isolation.  Results Thirty-six cases of AF ablation were analyzed (11 de novo, 25 redo). A total of 36 PVG in 13 (36%) patients were detected after remap (1 case of de novo) or initial map of redo patients (12 cases). A total of 34 RAP in 20 cases (56%) were found: 4 (36%) cases of de novo (all after ablation and remap) and 16 (64%) cases of redo (all after initial map). In 7 (19%) cases we found at least one RAP in pts with complete absence of PV conduction. 100% of PVG (n = 36) and 89% of RAP (n = 29) were fully detected though a first pass automated annotation. In 5 RAPs (11%) an additional temporal consistency of low-voltage signal relative to neighboring activation was needed due to the very low voltage EGM (≤0.1 mV). PVGs were more common at right PV sites (n = 26, 72%) and anterior PV sites (n = 20, 55.6%) whereas RAPs were detected more frequently at left PV sites (n = 20, 59%) and anterior PV sites (n = 21, 62%). RAP showed a lower median voltage compared with PVG (0.22[0.2-0.3]mV for RAP vs 0.97[0.6-1.3]mV for PVG, p < 0.0001) whereas the median number of EGM peaks were higher (6.5[5-8] for RAP vs 3[2-4] for PVG, p < 0.0001). No complications during the procedures were reported. The acute procedural success was 100%, with all PVs successfully isolated and RAPs completely abolished in all study pts.  Conclusion In our preliminary experience, local vulnerabilities in antral lesion sets were commonly discernible using HDM system both in de novo or redo patients when no PV conduction was present. The applied workflow seemed to be useful to quickly pinpoint and accelerate the search of local PV activity or concealed low-voltage activity.

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