Prevalence, characteristics, and predictors of endocardial and nonendocardial conduction gaps during local impedance‐guided extensive pulmonary vein isolation of atrial fibrillation with high‐resolution mapping

2021 ◽  
Author(s):  
Kohki Nakamura ◽  
Takehito Sasaki ◽  
Kentaro Minami ◽  
Yutaka Take ◽  
Mitsuho Inoue ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Resolution ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
High Resolution Mapping ◽  
Resolution Mapping

scholarly journals Novel noncontact charge density map in the setting of post-atrial fibrillation atrial tachycardias: first experience with the Acutus SuperMap Algorithm

2020 ◽  
Author(s):  
Robbert Ramak ◽  
Gian-Battista Chierchia ◽  
Gaetano Paparella ◽  
Cinzia Monaco ◽  
Vincenzo Miraglia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Resolution ◽  
Charge Density ◽  
Pulmonary Vein ◽  
The Novel ◽  
Mapping Algorithm ◽  
Af Ablation ◽  
High Resolution Mapping ◽  
Resolution Mapping ◽  
The Mean

Abstract Purpose The purpose of this study was to evaluate the safety and feasibility of the new high-resolution mapping algorithm SuperMap (Acutus Medical, CA, USA) in identifying and guiding ablation in the setting of regular atrial tachycardias following index atrial fibrillation (AF) ablation. Methods Seven consecutive patients who underwent a radiofrequency catheter ablation guided by the novel noncontact charge density (CD) SuperMap for atrial tachycardia were prospectively enrolled in our study. Results Arrhythmogenic substrate was identified in all seven patients. Mean number of EGM per map was 5859.7 ± 4348.5 points. Three patients (43%) exhibited focal tachycardia mechanisms in the left atrium, alternating from anteroseptal right superior pulmonary vein (RSPV), posterior in proximity of left inferior pulmonary vein (LIPV), and interarial septum in proximity of fossa ovalis, respectively. Four patients exhibited macroreentrant mechanism. In 3 of these patients, SuperMap detected mitral isthmus-dependent flutters with tachycardia cycle lengths of 240, 270 and 420 ms, respectively. In one patient, the mechanism was a macroreentrant tachycardia with the critical isthmus located between the crista terminalis and atriotomy. The mean ablation time (min) was 18.2 ± 12.5 and the mean procedural duration time was 56.4 ± 12.1 min. No minor or major complications occurred. Conclusion The novel high-resolution mapping algorithm SuperMap proved to be safe, fast, and feasible in identifying and guiding ablation in the setting of regular atrial tachycardias following index AF ablation.

Pulmonary vein-gap re-entrant atrial tachycardia following atrial fibrillation ablation: an electrophysiological insight with high-resolution mapping

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1039-1047 ◽  
Author(s):  
Seigo Yamashita ◽  
Masateru Takigawa ◽  
Arnaud Denis ◽  
Nicolas Derval ◽  
Yuichiro Sakamoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Resolution ◽  
Pulmonary Vein ◽  
Atrial Tachycardia ◽  
Atrial Fibrillation Ablation ◽  
P Wave ◽  
Conduction Time ◽  
High Resolution Mapping ◽  
Mapping System ◽  
Resolution Mapping

Aims The circuit of pulmonary vein-gap re-entrant atrial tachycardia (PV-gap RAT) after atrial fibrillation ablation is sometimes difficult to identify by conventional mapping. We analysed the detailed circuit and electrophysiological features of PV-gap RATs using a novel high-resolution mapping system. Methods and results This multicentre study investigated 27 (7%) PV-gap RATs in 26 patients among 378 atrial tachycardias (ATs) mapped with Rhythmia™ system in 281 patients. The tachycardia cycle length (TCL) was 258 ± 52 ms with P-wave duration of 116 ± 28 ms. Three types of PV-gap RAT circuits were identified: (A) two gaps in one pulmonary vein (PV) (unilateral circuit) (n = 17); (B) two gaps in the ipsilateral superior and inferior PVs (unilateral circuit) (n = 6); and (C) two gaps in one PV with a large circuit around contralateral PVs (bilateral circuit) (n = 4). Rhythmia™ mapping demonstrated two distinctive entrance and exit gaps of 7.6 ± 2.5 and 7.9 ± 4.1 mm in width, respectively, the local signals of which showed slow conduction (0.14 ± 0.18 and 0.11 ± 0.10m/s) with fragmentation (duration 86 ± 27 and 78 ± 23 ms) and low-voltage (0.17 ± 0.13 and 0.17 ± 0.21 mV). Twenty-two ATs were terminated (mechanical bump in one) and five were changed by the first radiofrequency application at the entrance or exit gap. Moreover, the conduction time inside the PVs (entrance-to-exit) was 138 ± 60 ms (54 ± 22% of TCL); in all cases, this resulted in demonstrating P-wave with an isoelectric line in all leads. Conclusion This is the first report to demonstrate the detailed mechanisms of PV-gap re-entry that showed evident entrance and exit gaps using a high-resolution mapping system. The circuits were variable and Rhythmia™-guided ablation targeting the PV-gap can be curative.

scholarly journals Regional entrainment of atrial fibrillation studied by high-resolution mapping in open-chest dogs.

Circulation ◽  
1993 ◽  
Vol 88 (2) ◽  
pp. 736-749 ◽  
Author(s):  
C Kirchhof ◽  
F Chorro ◽  
G J Scheffer ◽  
J Brugada ◽  
K Konings ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Resolution ◽  
High Resolution Mapping ◽  
Open Chest ◽  
Resolution Mapping
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