Open-window mapping of accessory pathways utilizing high-density mapping

Schricker, Amir; Winkle, Roger A.; Moskovitz, Ryan; Suchomel, Lucas; Fowler, Steven J.; Engel, Gregory S.; Cho, Shaun; Salcedo, Jonathan; Woods, Christopher

doi:10.1007/s10840-020-00850-7

Cited by 28 publications

(42 citation statements)

References 13 publications

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“…The CARTO system and Ensite system can annotate only atrial or ventricular potentials and are not able to distinguish between atrial and ventricular potentials during the same maps. Schricker et al 2 reported new open‐window mapping of APs using the Ensite system. Although the activation of the ventricle, atrium, and activation breakout site via the AP can be visualized with this method, the atrio‐ventricular (AV) annulus could not be visualized automatically 2 .…”

Section: Discussionmentioning

confidence: 99%

“…The conventional approach of 3D mapping for accessory pathway (AP) ablation has been single‐chamber mapping and displays the earliest atrial or ventricular activation. Simultaneous atrial and ventricular mapping using open‐window mapping has been reported in 23 patients with APs, and this technique effectively localized the APs 2 . The Rhythmia mapping system (Boston Scientific), which uses a small basket array with 64‐polar mini‐electrodes (IntellaMap Orion, Boston Scientific), enables rapid ultrahigh‐density mapping in a short time 3–5 .…”

Section: Introductionmentioning

confidence: 99%

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Ultrahigh density atrio‐ventricular dual‐chamber mapping as a next generation tool for ablation of accessory pathways

Mori

Kawano

Sumitomo

et al. 2021

Cardiovasc electrophysiol

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Introduction Detailed three‐dimensional (3D) mapping has been useful for effective radiofrequency catheter ablation. The Rhythmia system can create atrio‐ventricular dual‐chamber mapping, which reveals the atrial and ventricular potentials all at once in the same map. The aim of this study was to investigate the utility of mapping the atrium and ventricle simultaneously with a high‐density 3D mapping system for the ablation of accessory pathways (AP). Methods From July 2015 to August 2020, 111 patients underwent ablation of APs. Dual‐chamber maps were created in 50 patients (median age 15 [10–54], 32 male [64.0%]), while 61 patients underwent radiofrequency (RF) ablation with conventional single‐chamber 3D maps. The background characteristics and procedural details were compared between the dual‐chamber mapping group and the conventional single‐chamber mapping group. Results The number of RF applications (median [IQR]; 1.0 [1.0–3.0] vs. 3.0 [1.0–6.0], p = .0023), RF time (median [IQR], s; 9.2 [2.0–95.7] vs. 95.6 [4.1–248.7], p = .0107), and RF energy (median [IQR], J; 248.4 [58.7–3328.2] vs. 2867.6 [134.2–7728.4], p = .0115) were significantly lower in the dual‐chamber group. The fluoroscopy time (median [IQR], min; 19.9 [14.2–26.1] vs. 26.5 [17.7–43.4], p = .0025) and fluoroscopy dose (median [IQR], mGy; 52.5 [31.3–146.0] vs. 119.0 [43.7–213.5], p = .0249) were also significantly lower in the dual‐chamber than single‐chamber mapping group. Conclusion The dual‐chamber mapping was useful for ablating accessory pathways and reducing the number of RF applications, total RF energy, and radiation exposure as compared with traditional mapping techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultrahigh density atrio‐ventricular dual‐chamber mapping as a next generation tool for ablation of accessory pathways

Mori

Kawano

Sumitomo

et al. 2021

Cardiovasc electrophysiol

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“…High-density, three-dimensional mapping was performed across the posteroseptal aspect of the tricuspid valve during sinus rhythm using the Advisor™ HD Grid Mapping Catheter, Sensor Enabled™ and the EnSite Precision™ electroanatomic mapping system. We employed the open-window mapping (OWM) strategy described by Schricker et al 1 OWM relies on the maximum absolute dV/dt value from each bipolar signal on the high-density grid to collect activation points in patients with accessory pathway conduction. The “open window” does not distinguish atrial, pathway, and ventricular signals from one another and mapping leads to visualization of the channel of activation across the mapping segment (in this case, the tricuspid valve).…”

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confidence: 99%

High-density Mapping of a Posteroseptal Accessory Pathway Using Open-window Mapping

Frisch

2020

J Innov Cardiac Rhythm Manage.

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“…Transseptal puncture allowed access to the left atrium and left ventricle, where high-density mapping was performed across the mitral valve anulus during ventricular pacing using the Advisor™ HD Grid Mapping Catheter, Sensor Enabled™ and the EnSite Precision™ electroanatomic mapping system to localize the concealed left lateral accessory pathway. The open-window mapping technique 1 was used by collecting the absolute dV/dt bipolar electrogram from the high-density grid to help distinguish the mitral valve anulus, collecting both atrial and ventricular electrograms to delineate functional block located at the valve plane ( Figure 1B ) . At the location of the accessory pathway, bipolar fusion and pathway potentials recognized and annotated on the high-density grid were able to showcase the atrial insertion point of the accessory pathway ( Figures 1B and 1C ).…”

mentioning

confidence: 99%