Novel noncontact charge density map in the setting of post-atrial fibrillation atrial tachycardias: first experience with the Acutus SuperMap Algorithm

Abstract

Purpose The purpose of this study was to evaluate the safety and feasibility of the new high-resolution mapping algorithm SuperMap (Acutus Medical, CA, USA) in identifying and guiding ablation in the setting of regular atrial tachycardias following index atrial fibrillation (AF) ablation. Methods Seven consecutive patients who underwent a radiofrequency catheter ablation guided by the novel noncontact charge density (CD) SuperMap for atrial tachycardia were prospectively enrolled in our study. Results Arrhythmogenic substrate was identified in all seven patients. Mean number of EGM per map was 5859.7 ± 4348.5 points. Three patients (43%) exhibited focal tachycardia mechanisms in the left atrium, alternating from anteroseptal right superior pulmonary vein (RSPV), posterior in proximity of left inferior pulmonary vein (LIPV), and interarial septum in proximity of fossa ovalis, respectively. Four patients exhibited macroreentrant mechanism. In 3 of these patients, SuperMap detected mitral isthmus-dependent flutters with tachycardia cycle lengths of 240, 270 and 420 ms, respectively. In one patient, the mechanism was a macroreentrant tachycardia with the critical isthmus located between the crista terminalis and atriotomy. The mean ablation time (min) was 18.2 ± 12.5 and the mean procedural duration time was 56.4 ± 12.1 min. No minor or major complications occurred. Conclusion The novel high-resolution mapping algorithm SuperMap proved to be safe, fast, and feasible in identifying and guiding ablation in the setting of regular atrial tachycardias following index AF ablation.

Atrial Fibrillation Global Changes after Pulmonary Vein and Posterior Wall Isolation: A Charge Density Mapping Study

“…Through a single transseptal puncture, the AcQMap catheter was advanced over a guide wire into the LA via an Acquire (Acutus Medical, Carlsbad, CA, USA) sheath [ 22 , 23 ]. Ultrasound was used to reconstruct the 3D high-resolution atrial anatomy, and the wavefront models were examined in real time with the use of an integral application (AcQTrack Acutus Medical).…”

Current understanding of atrial fibrillation recurrence after atrial fibrillation ablation: From pulmonary vein to epicardium

“…Based on the non-contact mapping with one single beat, it helps interpretation of complex ATs with variations in cycle length or CS activation pattern, exhibiting localized rotational or irregular activation and focal activation. 52,53 It offered the strategy of PVI plus patient-tailored ablation with high acute success, but the recurrence differed in previous reports. 52,54,55 The system facilitates rapid visualization of tachycardia circuits, while the algorithm derived from mathematical assumptions may affect arrhythmia interpretations.…”

“…Recently, a novel mapping modality, the AcQMap system (Acutus Medical, Carlsbad, CA) provides ultrasound‐acquired anatomy and an inverse algorithm to derive charge density. Based on the non‐contact mapping with one single beat, it helps interpretation of complex ATs with variations in cycle length or CS activation pattern, exhibiting localized rotational or irregular activation and focal activation 52,53 . It offered the strategy of PVI plus patient‐tailored ablation with high acute success, but the recurrence differed in previous reports 52,54,55 .…”

Global Substrate Mapping and Targeted Ablation with Novel Gold-tip Catheter in De Novo Persistent AF

“…algorithm in a small series (n=7) of patients undergoing ablation of complex ATs following AF ablation. 57 Shi et al applied computational modelling to identify the optimum minimum number of catheter positions required to achieve a threshold of accuracy in local activation time annotation. A total of 60 separate locations was shown to meet this accuracy threshold which was achieved within a maximum of 3 minutes of continuous catheter roving.…”