Catheter ablation of ventricular arrhythmia guided by a high‐density grid catheter

Abstract

Introduction: Minimal data exist on the Advisor HD Grid (HDG) catheter and the Precision electroanatomic mapping (EAM) system for ventricular arrhythmia (VA) procedures. Using the HDG catheter, the EAM uses the high-density (HD) wave mapping and best duplicate software to compare the maximum peak-to-peak bipolar voltages within a small zone independent of wavefront direction and catheter orientation. This study aimed to summarize the procedural experience for VAs using the HDG catheter.Methods: Clinical and procedural characteristics of VA ablation procedures were retrospectively reviewed that used the HDG catheter and the Precision EAM over a 12-month period.Results: A total of 22 patients, 18 with sustained ventricular tachycardia and 4 with premature ventricular contractions were included. Clinically indicated left and/or right ventricular (LV, RV, respectively), and aortic maps were created. LV substrate maps (n = 13) used a median 1700 points (interquartile range [IQR] 25%-75% , 1427-2412) out of a median 18 573 (IQR 25%-75% , 15 713-41 067) total points collected. RV substrate maps (n = 11) used a median 1435 points (IQR 25%-75% , 1114-1871) out of a median 16 005 (IQR 25%-75% , 11 063-21 405) total points collected. Total point utilization, used vs collected, was 9%. Mean mapping time was 43 ± 17 minutes (substrate, 34 ± 18 minutes; activation/pace mapping, 9 ± 13 minutes). Acute success was achieved in 56 (86%) and short-term success achieved in 16 patients (73%) at a median follow-up of 145 days (IQR 25%-75% , 62-273 days). There were no procedural complications.Conclusion: HD wave mapping using the novel HDG catheter integrated with the Precision EAM is safe and feasible in VA procedures in the LV, RV, and aorta.Mapping times are consistent with other multielectrode mapping catheters. K E Y W O R D Scatheter ablation, electroanatomic mapping, electrophysiology, multielectrode mapping, ventricular arrhythmias

Multipolar mapping with the high‐density grid catheter compared with conventional point‐by‐point mapping to guide catheter ablation for focal arrhythmias

“…Clinical studies have demonstrated the usefulness of the HDG catheter in patients undergoing CA for atrial fibrillation and ventricular arrhythmias in structural heart disease 4–6,8,24 . A novel feature of the HDG catheter is an ability to create bipolar EGMs at orthogonal directions to account for the direction of wavefront propagation 4 . Previous studies have shown that the electrode orientation in relation to wavefront activation is in part responsible for the bipolar EGM 21,26 .…”

“…3D mapping was performed using the Ensite™ Precision/Velocity™ electroanatomic mapping (EAM) system (Abbott Medical), with interior projection setting set at 7 mm and bipolar signal filtering at 30–500 Hz. The Ensite EAM incorporates the HD Wave solution and best duplicate algorithm to select the EGM with the largest amplitude at orthogonal bipoles 4,8 within a 1‐mm zone. All ablations in the HDG cohort were performed using the irrigated, contact force sensing TactiCath™ SE catheter, with a contact force between 10 and 25 g. Power settings utilized were as per operator discretion, typically 25–40 W for atrial ablation and 30–40 W for ventricular ablation.…”

“…The Advisor™ HD Grid catheter is a novel multielectrode mapping catheter arranged in a 4 × 4 grid configuration which allows for orthogonal bipole recordings along and across its splines. Whilst its use had been reported in mapping scar‐related ventricular tachycardia (VT) or complex atrial arrhythmias, 4–6 the utility of the high‐density grid (HDG) catheter to guide ablation for focal arrhythmias has not been well‐described. The aim of the present study was to compare the procedural and clinical outcomes of mapping and ablation of focal arrhythmias using multipolar mapping (MPM) with the HDG catheter with a matched cohort using conventional PbyP mapping.…”

Ventricular Arrhythmia Burden as a Marker of Success Following Catheter Ablation of Ventricular Arrhythmias in Patients with Structural Heart Disease

“…Our approach to mapping and ablation of scar-related ventricular tachycardia (VT) has been described previously. 9) 10) Procedures were performed under either conscious sedation or general anaesthesia. An SL3 sheath (Abbott Medical, Abbott Park, IL, USA) was used to perform coronary sinus venography and a decapolar catheter inserted into the coronary sinus.…”

Prognostic significance of extensive versus limited induction protocol during catheter ablation of scar‐related ventricular tachycardia

“…Our approach to mapping and ablation of scar‐related VT has been described previously 16,20 . Procedures were performed under either conscious sedation or general anesthesia 3,12,17 .…”