2019 APHRS expert consensus statement on three‐dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS

Single-loop incisional atrial tachycardia encircling the entire right atrium: Where is the critical isthmus?

“…Advancements in the three-dimensional mapping systems and automated annotation algorithms has permitted us to create high-resolution maps with an adequate point density. 7 Of importance, we need to acknowledge that the critical areas of arrhythmogenesis mostly occur in diseased tissue where the voltage is attenuated, and handling the low voltages and complex electrograms is still a challenge when creating a precise electro-anatomical map. In this case, we obtained clear boundaries between the scar and healthy myocardium using the CARTO3 mapping system, but the results might have been different using a more high-density and high-resolution mapping system (Rhythmia; Boston Scientific, Cambridge, MA).…”

Esophageal Signals as Reference Guide for Ablations in Congenital Heart Diseases

“…In complex congenital hearts reentries involving atria and ventricle scar areas are common with changing proportion to underlying disease or surgery as well as atrio-ventricular or nodal reentries or ectopic tachycardia. [4] 3D-electroanatomical mapping is recommended as class I for atrial and ventricular tachycardia in congenital heart diseases [5] which is reported to facilitate RFCA procedures for different types of arrhythmia mechanisms. All the mapping systems based on reference signal, and mapping catheter for electro anatomical mapping procedures.…”

Mahaim pathway potential revealed by high-resolution three-dimensional mapping

“…If the pathway has been accidentally blocked, the AP can readily be relocated as the mapping system saves every beat and the corresponding catheter position and electrograms. In fact, using a Pentaray® for Mahaim APs was first reported by colleagues from Heidelberg after a failed conventional approach [ 4 ], and the novel expert consensus on 3D mapping systems for tachycardia [ 5 ] recommends the use of a 3D mapping system for localization and ablation of APs with lower success and higher recurrence rates, such as right-sided APs. In addition to improving mapping and ablation success, high-definition 3D mapping can provide further insights into the Mahaim anatomy and physiology, as elegantly demonstrated by Nishimura et al., who delineated the entire Mahaim pathway activation from TA to right ventricular breakout site [ 6 ].…”