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

Abstract

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.

Impact of a high-density grid catheter on long-term outcomes for structural heart disease ventricular tachycardia ablation

“…Despite this index correlating with pacemap and entrainment map defined VT isthmus sites in 72% of VTs, 16 month follow-up resulted in a 50% recurrence rate [38]. The advantages of HD Grid mapping versus PbyP RF mapping in focal arrythmias with normal structural hearts has been recently highlighted, with significantly earlier electrograms at the site of successful ablation and a significant reduction in map and procedure times [39]. However, neither of these positive outcomes impacted on acute procedural or long-term success.…”

Integration of 3D nuclear imaging in 3D mapping system for ventricular tachycardia ablation in patients with implanted devices: Perfusion/voltage retrospective assessment of scar location

“…Publications comparing high-resolution catheter to point-by-point mapping with linear catheters reported LV substrate voltage maps with a density of points used ranging between 1500 and more than 3000 with high-resolution catheter. 21 , 22 , 23 Likewise, SPECT/CT 3D geometries are composed of vertices, ie, coordinate in space, that will define the geometry spatial resolution, including the anatomical landmarks, and be associated to physiological values (tissue perfusion, voltage, etc) to display different maps. Anatomically, well-defined imaging and EAM geometries will provide exhaustive anatomical landmarks for an increased registration accuracy.…”

Nonsustained premature atrial contraction ablation guided by single-beat mapping using charge density mapping

“…Occasionally, atrial tachycardia (AT) episodes may be nonsustained, limiting the ability to perform activation mapping and subsequent ablation. 1 In some patients, these nonsustained episodes may be symptomatic, negatively impact quality of life, and be refractory to medical therapy. 2 Furthermore, these patients may not be offered ablation, since these brief episodes may be considered unmappable.…”