Comparison between novel and standard high-density 3D electro-anatomical mapping systems for ablation of atrial tachycardia

Objective To evaluate the role of ultrahigh‐density mapping for conduction isthmus (CI) characterization in adult congenital heart disease (ACHD). Background Catheter ablation remains suboptimal for ACHD with atypical intra‐atrial reentrant tachycardias (IART) that can be challenging to define using existing mapping technology. Methods An ultrahigh‐density mapping system was selectively employed over a 1‐year period for procedures involving noncavotricuspid isthmus‐dependent‐IART. A global activation histogram (GAH) was assessed for the ability to predict ablation targets. Procedural characteristics were compared to a group of matched controls. Results Twenty patients (mean age 43 ± 15, 70% male) underwent 20 procedures targeting 34 tachycardias during the study period. Diagnoses included single ventricle (8), tetralogy of Fallot (2), left heart obstruction (3), Ebstein's anomaly (2) atrial septal defect (2), Mustard operation (2), and Rasteilli operation (1). Prior catheter ablation/Maze operation had been performed in 12 (60%). The median time per map was 21 minutes (interquartile range [IQR], 16‐32), representing 14 834 points per map (IQR 9499‐43 191; P < .001 vs controls). Review of GAH maps showed lower trough values were associated with more favorable IART CI characteristics (P ≤ =.001 for all). Acute success was achieved in 19/20 (95%) procedures, with tachycardia termination during the first lesion in eight cases (P = .02 vs controls). There was one recurrence during 0.6 years follow‐up. Conclusions Ultrahigh‐density mapping supplemented with the GAH tool was effective for CI identification in a cohort of complex ACHD patients. Catheter ablation was more efficient compared to controls, suggesting precise CI characterization using this technology.

Section: Discussionmentioning

confidence: 99%

Section: Ultrahigh-density Mapping In Congenital Heart Diseasementioning

confidence: 99%

Ultrahigh‐density mapping supplemented with global chamber activation identifies noncavotricuspid‐dependent intra‐atrial re‐entry conduction isthmuses in adult congenital heart disease

Moore

Buch

Gallotti

et al. 2019

“…Several single-center and one multicenter study report acute success rates between 77% and 97% targeting ATs following prior catheter ablation or cardiac surgery. 20,[31][32][33][34] After a mean follow-up of 1 year, Maury et al, 32 who compared conventional point-by-point 3D mapping with HDM, reported freedom from AT recurrence in 50% in the conventional and 63% in the HDM group. A recent study using HDM in 147 patients describes freedom from scar-related ATs in 54% of patients after a mean follow-up of 4.2 months.…”

Section: Discussionmentioning

confidence: 99%

Outcome after tailored catheter ablation of atrial tachycardia using ultra‐high‐density mapping

Jungen

Akbulak

Kahle³

et al. 2020

Introduction: Tailored catheter ablation of atrial tachycardias (ATs) is increasingly recommended as a potentially easy treatment strategy in the era of high-density mapping (HDM). As follow-up data are sparse, we here report outcomes after HDMguided ablation of ATs in patients with prior catheter ablation or cardiac surgery. Methods and Results: In 250 consecutive patients (age 66.5 ± 0.7 years, 58% male) with ATs (98% prior catheter ablation, 13% prior cardiac surgery) an HDM-guided catheter ablation was performed with the support of a 64-electrode mini-basket catheter. A total of 354 ATs (1.4 ± 0.1 ATs per patient; mean cycle length 304 ± 4.3 ms; 64% macroreentry, 27% localized reentry, and 9% focal) with acute termination of 95% were targeted in the index procedure. A similar AT as in the index procedure recurred in five patients (2%) after a median follow-up time of 535 days (interquartile range (IQR) 25th-75th percentile: 217-841). Tailored ablation of reentry ATs with freedom from any arrhythmia was obtained in 53% after a single procedure and in 73% after 1.4 ± 0.4 ablation procedures (range: 1-4). A total of 228 patients (91%) were free from any arrhythmia recurrence after 210 days (IQR: 152-494) when including optimal usual care. Conclusions: Tailored catheter ablation of ATs guided by HDM has a high acute success rate. The recurrence rate of the index AT is low. In patients with extensive atrial scaring further ablation procedures need to be considered to achieve freedom from any arrhythmia.

“…The role of multipolar catheters in focal arrhythmias in the absence of a diseased substrate is less well established. A number of catheter designs with considerable variation in size, spacing, and a number of electrodes have become available 13–15 and continue to evolve. Potential advantages of multipolar catheters include higher mapping resolution with less signal averaging and cancellation effects from larger electrodes.…”

Section: Discussionmentioning

confidence: 99%

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

Chieng

Lahiri

Sugumar

et al. 2020

Background Multipolar catheters provide high‐density mapping which may reduce the procedural duration and improve the success of catheter ablation (CA) for focal arrhythmias. The high‐density grid (HDG) catheter is a 16 electrode mapping catheter with bipole recordings at orthogonal splines. The aim of this study is to compare the clinical and procedural features from a cohort who underwent CA for focal arrhythmias using multipolar mapping (MPM) with age and case‐matched cohort using point‐by‐point (PbyP) mapping. Methods Consecutive patients undergoing CA for focal arrhythmias between October 2018 and January 2020 guided by MPM were compared with PbyP mapping with the ablation catheter over a similar period. Demographics, procedural features, and outcomes were compared. Results A total of 54 patients (27 in MPM vs. 27 in PbyP mapping) underwent CA for 68 focal arrhythmias (26 atrial and 42 ventricular). In the MPM group, the electrogram at the successful site was significantly earlier (39 ± 11 ms) than in the PbyP group (33 ± 7 ms; p = .02). In the MPM group, the mapping time (35 ± 24 vs. 53 ± 31 min in PbyP; p = .03) and procedural duration (126 ± 42 vs. 153 ± 39 min in PbyP; p = .02) were significantly shorter. There was no significant difference in radiofrequency and fluoroscopy times, acute procedural success, and arrhythmia recurrence. Conclusion MPM with the HDG catheter for focal tachycardias identified earlier activation times and was associated with shorter mapping and procedure duration with equivalent success to PbyP mapping.