Anatomical accuracy of the KODEX‐EPD novel 3D mapping system of the left atrium during pulmonary vein isolation: A correlation with computer tomography imaging

Abstract

Background: A novel 3D mapping system (KODEX-EPD, EPD Solutions) enables catheter localization and real-time 3D cardiac mapping.Objective: To evaluate left atrium (LA) anatomical mapping accuracy created by the KODEX-EPD system during pulmonary vein isolation (PVI) compared with gold standard computed tomography (CT) images acquired from the same patients before the procedure.Methods: In 15 consecutive patients who underwent PVI, 3D mapping of the LA was created on the KODEX-EPD system using the Achieve catheter. Pulmonary vein (PV), posterior wall, and appendage anatomy and diameters, were compared to the CT 3D reconstruction measured on the CARTO 3 system. Measurements were done independently by two physicians in each method. Linear correlation and agreement between CT and EPD measurements were assessed by Spearman correlation and Bland-Altman plot.Results: Mean LA mapping time was 7.7 ± 3.6 min. Very high interobserver correlation was found for both EPD and CT measurements (Spearman r = .9). High correlation (r = .75) was found between CT and EPD measurements. Bland-Altman plot method revealed that measurements assessed by EPD were slightly higher than those assessed by CT. Mean difference was 3.5 mm, p < .01. In 2 (13.5%) patients each, disagreement regarding the presence of a left common PV and a right middle accessory vein anatomy was seen. Conclusion:The new KODEX-EPD mapping system allows quick and accurate mapping of the LA with high correlation to CT imaging. Some differences in left common and accessory right middle vein anatomy were seen.

Cryoablation Utilizing the KODEX-EPD Mapping System Versus Conventional Cryoballoon Ablation in the Management of Patients With Atrial Fibrillation: A Literature Review and Meta-Analysis

“…A previous study compared high-density KODEX-EPD mapping versus 3D computed tomography (CT) imaging in mapping the left atrium. This study concluded that the KODEX-EPD system provides an accurate and fast mapping technique with high reliability when utilized in cases of atrial ablation [34].…”

Contributions of Israel to the field of clinical cardiac electrophysiology and implantable devices

“…The 2 most recent original papers dealing with AF ablation originate from Shaare Zedek Hospital (Jerusalem). Tovia-Brodie and coworkers 135 reported the anatomical accuracy of the KODEX-EPD (Philips, Netherlands) novel 3D mapping system of the left atrium during pulmonary vein isolation and its excellent correlation with computer tomography imaging. In the second paper, Rav Acha and colleagues 136 showed that cryoballoon AF ablation results in circumferential pulmonary vein fibrosis in the majority of pulmonary veins, as assessed by a new clinically relevant magnetic resonance imaging (MRI) analysis.…”