Ablation of atypical atrial flutter is challenging and time consuming. This case series shows that HD-VGM mapping can quickly localize and terminate an atypical flutter circuit.
Background: This study describes the use of lesion index (LSI) as a direct measure to assess the adequacy of ablation lesion formation with force-sensing catheters in ablation of paroxysmal atrial fibrillation (PAF). LSI is calculated by the formula:LSI = CF (g) ×Current (mA) ×Time (sec). Methods: Fifty consecutive patients with PAF underwent pulmonary vein (PV) isolation using a catheter dragging technique and targeting different LSI values in different anatomical areas.A force-sensing ablation catheter was used to continuously measure contact force (CF) and guide radiofrequency ablation (RF) lesion formation. Ablation lesions were delivered to achieve an LSI value of 5.0 in posterior locations, 5.5 in anterior locations and 6.0 in the region between the left atrial appendage and left superior pulmonary vein ridge. Force-time Integral (FTI) was not used to evaluate lesion formation. Results: A single center, retrospective analysis was performed with 196/198 (99%) PVs acutely isolated. The mean procedure time was 134 ± 34 mins and the mean fluoroscopy time was 7.8 ± 3.2 mins. At a mean follow up of two years, 43/50 (86%) of patients were in normal sinus rhythm with no documented recurrences of atrial fibrillation. Conclusion: LSI can be used to guide the placement of durable lesion formation with RF ablation using CF catheters in patients with PAF.
Multipoint high density voltage gradient mapping can help identify maximum voltage areas within the isthmus and when ablated can create bidirectional block with decreased ablation times and length of the lesion.
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