Treatment of Macro-Reentry Atrial Tachycardia with Very High-Power, Short-Duration, Temperature-Controlled Ablation of Anterior Line Using an Open-Irrigated Ablation Catheter with Microelectrodes

Abstract

Patient: Male, 74-year-old Final Diagnosis: Atrial fibrillation Symptoms: Tachycardia Medication:— Clinical Procedure: — Specialty: Cardiology Objective: Unusual clinical course Background: Treatment of atrial fibrillation and atrial tachycardia (AT) with catheter ablation results in high rates of success with the procedure and on long-term follow-up. A novel ablation catheter with a very high-power, short-duration (vHPSD) ablation mode using 90 W for 4 s has been introduced, which could improve safety and efficacy of catheter ablation, especially for pulmonary vein isolation (PVI). To date, vHPSD mode has only been evaluated for treatment of PVI, but it could be an efficient technique for linear lesions. Here, we present the first use of the novel vHPSD mode alone for catheter ablation in a patient with peri-mitral AT (PMAT). Case Report: A 74-year-old man presented with symptomatic AT. An electroanatomic reconstruction of his left atrium showed PMAT with a potential critical isthmus on the anterior wall. Therefore, ablation of an anterior line was performed. The patient’s AT stopped after 10 applications and less than 40 s of radiofrequency (RF) ablation. Afterward, the anterior line was completed with a total of 29 applications of vHPSD and a RF time of 116 s. PVI and blockage of the cavotricuspid isthmus also were performed. The total procedure time was 107 min. No periprocedural complications occurred. Conclusions: The present case demonstrates the safety and efficacy of treatment of AT with a novel catheter that delivers vHPSD ablation to an anterior line.

Pulmonary vein isolation durability after very high-power short-duration ablation utilizing a very-close protocol – The FAST AND FURIOUS redo study

“…In patients with AT a high-density activation mapping utilizing a 3D electroanatomical mapping system (Carto or EnsiteX) of the LA was assessed and the AT was treated according to the institutional standards. [13] The ablation strategies during repeat procedures are mentioned in Table 3 . Briefly, perimitral AT was detected in 6 patients (vHP-SD) and 3 patients (control) and was treated by performing an anterior line due to scar formation at the anterior aspect of the LA.…”

Very high‐power short‐duration catheter ablation for treatment of cardiac arrhythmias: Insights from the FAST and FURIOUS study series

“…Although the QDOT MICRO™ Catheter was designed for atrial procedures data on the treatment of atrial tachycardia is limited to only one published case report 39 …”

“…Here complete CTI block using vHPSD ablation was achieved in all 15 patients. A median of 23 (20,39) RF applications over a median RF ablation time of 92 (78, 154) s were applied and no periprocedural complications, no charring, and no steam pops were observed. 49 The preliminary data show that vHPSD ablation might represent an effective and safe strategy to achieve bidirectional CTI block for the treatment of typical AFL.…”

“…Although the QDOT MICRO™ Catheter was designed for atrial procedures data on the treatment of atrial tachycardia is limited to only one published case report. 39 Here a patient with perimitral atrial tachycardia with a critical isthmus on the anterior wall was treated by the QDOT MICRO™ Catheter utilizing QMODE+ only. An ablation of an anterior line was performed.…”

“…The combination of microelectrodes and vHPSD ablation seems to be an interesting option for mapping and ablation of atrial tachycardias (Figure 4). 39 Please also see Supporting Information: Video 3 for perimitral AT ablation by vHPSD only.…”