Multi-electrode mapping of complex macroreentry atrial tachycardia

High density mapping of complex atrial tachycardia in patients after cardiac surgery

“…18 In another study compared conventional activation mapping performed by Thermocool using the Carto 3 system with MEM in scar-related ATs, MEM showed a shorter procedure duration and mapping duration with more mapping points, and lower recurrence risk of ATs post ablation. 1 The more recent 64-pole basket mapping catheter (IntellaMap Orion TM, Boston Scientific), which incorporates very small flat (0.4 mm 2 ; 2.5 mm spacing) and unidirectional electrodes, further improved these aspects. 20,21 Maps produced experimentally with the Rhythmia mapping system using this catheter had an unprecedented electrogram resolution (2.6 mm), the noise was very low (< 0.01 mV) and were highly accurate, without need for manual reannotation.…”

“…These scar‐related ATs are difficult to manage medically and frequently recur after electrical cardioversion 4 . The success of catheter ablation is decided by the precise diagnosis of the AT mechanism, which is challenging as a result of underlying cardiac disease and iatrogenic lesion sets with a resultant complex atrial substrate 1–3,5 . High‐density mapping (HDM) technologies have enabled rigorous elucidation of atrial arrhythmia mechanisms in patients post cardiac surgery 6 .…”

“…Multielectrode mapping (MEM) by 1 mm electrode catheters with a 2 mm interelectrode spacing (3 mm center‐to‐center; PentaRay, Biosense‐Webster) have been introduced and widely used along with the advent of automatic annotation of electrograms 19 . The PentaRay catheter is consisted of 20 electrodes arranged on five flexible radiated catheters, covering an area with a diameter of 3.5 cm, which can map any atrium 1 . The main advantages of PentaRay are following: (1) map the low voltage areas heterogeneity and locate the survival conduction bundle channels; (2) complete more accurate mapping in a short period by the smaller electrode spacing conduces to reduce signal super position, eliminate interference, and record the higher voltage bipolar electrocardiogram (3) the high current density permit low output pacing 18 .…”

“…The percentage of low voltage data points that had distinct electrograms that allowed annotation of local activation time (LAT) recorded with 1‐mm electrode catheter was 54.4%, while only 21.4% with 3.5‐mm electrode tip catheters 18 . In another study compared conventional activation mapping performed by Thermocool using the Carto 3 system with MEM in scar‐related ATs, MEM showed a shorter procedure duration and mapping duration with more mapping points, and lower recurrence risk of ATs post ablation 1 …”

“…Complex atrial tachycardias (ATs) is frequently scar-related, after history of previous cardiac surgery and large scars. [1][2][3] These scar-related ATs are difficult to manage medically and frequently recur after electrical cardioversion. 4 The success of catheter ablation is decided by the precise diagnosis of the AT mechanism, which is challenging as a result of underlying cardiac disease and iatrogenic lesion sets with a resultant complex atrial substrate.…”