Ultra–High-Density Activation Mapping to Aid Isthmus Identification of Atrial Tachycardias in Congenital Heart Disease

Martin, Claire; Yue, Arthur M.; Martin, Ruairidh; Claridge, Simon; Sawhney, Vinit; Combes, Nicolas; Heck, Patrick; Begley, David; Fynn, Simon P.; Snowdon, Richard; Seller, Neil; Murray, Steven R.; Shepherd, Ewen; Ezzat, Vivienne; Gajendragadkar, Parag R; Honarbakhsh, Shohreh; Takigawa, Masateru; Cheniti, Ghassen; Frontera, Antonio; Thompson, Nathaniel; Massouillie, G; Kitamura, Τakeshi; Wolf, Michael; Duchâteau, Josselin; Klotz, Nicolas; Vlachos, Konstantinos; Bourier, Félix; Lam, Anna; Pambrun, Thomas; Denis, Arnaud; Sacher, Frédéric; Cochet, Hubert; Jaı̈s, Pierre; Hocini, Mélèze; Haı̈ssaguerre, Michel; Iriart, Xavier; Thambo, Jean-Benoît; Derval, Nicolas

doi:10.1016/j.jacep.2019.08.001

Cited by 20 publications

(32 citation statements)

References 19 publications

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“…In this case, the identification of circuit was crucial for successful ablation, especially if P-wave morphology and intracardiac EGM activation could potentially suggest typical cavotricuspid-isthmus-dependent AFL, as shown in Figure 1. The high-resolution mapping catheter allowed us to detect residual slow conduction between the right atriotomy F I G U R E 1 Persistent atrial flutter with concentric coronary sinus activation (375 ms atrial cycle length) and the tricuspid valve, 4 and was extremely fast and accurate in order to define the scar. The Lumipoint ™ software, a new automated algorithm, was actually very effective since it could eliminate the subjectivity of the human eye analyzing thousands of EGMs in a matter of seconds.…”

Section: Discussionmentioning

confidence: 99%

Effective and fast characterization of a complex atrial flutter in patient with previous atrial surgery and ablation procedure: The importance of new ultra–high‐density mapping tools

Mascia

Sartori

Porto

2020

Clinical Case Reports

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Section: Discussionmentioning

confidence: 99%

Effective and fast characterization of a complex atrial flutter in patient with previous atrial surgery and ablation procedure: The importance of new ultra–high‐density mapping tools

Mascia

Sartori

Porto

2020

Clinical Case Reports

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“…Cutting-edge research will continue to transform catheter ablation, the most effective therapy for a gamut of atrial and ventricular tachyarrhythmias in patients with CHD (86). Advancements in high-density, non-contact, and non-invasive mapping carry the potential to generate quicker and more accurate electroanatomic maps (87,88). Success and complication rates stand to improve by breakthroughs in novel ablation modalities and innovations in catheter designs (89)(90)(91).…”

Section: Interventional Therapeutic Platformsmentioning

confidence: 99%

Lifespan Perspective on Congenital Heart Disease Research

Diller

Arvanitaki

Opotowsky

et al. 2021

Journal of the American College of Cardiology

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“…[1][2][3][4] Catheter ablation of atrial arrhythmias with high-definition (HD) three-dimensional mapping has been promising with good acutely procedural outcomes. 2,[5][6][7] However, success rates at follow-up were variable [6][7][8] especially for noncavotricuspid isthmus (non-CTI)-dependent substrates. 9,10 Prolonged ablations, often involving linear lesions, 6,[10][11][12] can be proarrhythmic.…”

Section: Introductionmentioning

confidence: 99%

Targeted cluster ablation of non‐CTI‐dependent atrial arrhythmias in congenital heart disease using ultrahigh‐definition mapping

Kefala

Claridge

Wijayagoonawardana

et al. 2022

Cardiovasc electrophysiol

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Background: Ablation of atrial arrhythmias in patients with congenital heart disease (CHD) has markedly improved with advanced mapping systems. However, recurrence rates remain high. The linear ablation strategy is not uncommonly practiced necessitating prolonged ablation times. We report the outcomes of adopting a strategy of minimal, cluster delivery of radiofrequency (RF) energy at critical substrates identified by ultrahigh-definition mapping for atrial arrhythmias in patients with CHD.Methods: Non-cavotricuspid isthmus (non-CTI) atrial tachycardias were ablated with a targeted ablation cluster technique (TACT) using an ultrahigh-density mapping system combined with multielectrode monitoring and endpoint determination in preference to linear ablation. The arrhythmia substrates, RF times, and acute-and medium-term success rates were studied.Results: Fifty-eight tachycardias were mapped and ablated in 42 procedures: 34 non-CTIs and 24 CTIs. A targeted ablation cluster was performed for non-CTI tachycardias, with a median ablation time of 3.1 min. In 53% of non-CTI tachycardias, arrhythmia termination was achieved with ≤2 RF applications. After a mean followup of 23.6 months, 27 (80%) patients were free of recurrent atrial arrhythmias. One of 34 targeted non-CTI tachycardia recurred, with a final success rate of 91%. Linear ablation was performed for CTI flutters with a median ablation time of 6.8 min (vs. non-CTIs, p = .006). Three of 21 tachycardias recurred due to reconnection of the ablation line but the final success rate was 100%. Conclusions:The TACT approach for non-CTI atrial arrhythmias in congenital patients as guided by the ultrahigh-density mapping is an effective method with short ablation times and excellent medium-term outcomes.

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Ultra–High-Density Activation Mapping to Aid Isthmus Identification of Atrial Tachycardias in Congenital Heart Disease

Cited by 20 publications

References 19 publications

Effective and fast characterization of a complex atrial flutter in patient with previous atrial surgery and ablation procedure: The importance of new ultra–high‐density mapping tools

Effective and fast characterization of a complex atrial flutter in patient with previous atrial surgery and ablation procedure: The importance of new ultra–high‐density mapping tools

Lifespan Perspective on Congenital Heart Disease Research

Targeted cluster ablation of non‐CTI‐dependent atrial arrhythmias in congenital heart disease using ultrahigh‐definition mapping

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