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Electro Anatomical Mapping

Tarek Zghaib, Ali Keramati, Jonathan Chrispin, Dong Huang, Muhammad A Balouch, Luisa Ciuffo, Ronald D Berger, Joseph E Marine, Hiroshi Ashikaga, Hugh Calkins, Saman Nazarian, David D Spragg
Background: Bipolar voltage mapping, as part of atrial fibrillation (AF) ablation, is traditionally performed in a point-by-point (PBP) approach using single-tip ablation catheters. Alternative techniques for fibrosis-delineation include fast-anatomical mapping (FAM) with multi-electrode circular catheters, and late gadolinium-enhanced magnetic-resonance imaging (LGE-MRI). The correlation between PBP, FAM, and LGE-MRI fibrosis assessment is unknown. Objective: In this study, we examined AF substrate using different modalities (PBP, FAM, and LGE-MRI mapping) in patients presenting for an AF ablation...
January 2018: JACC. Clinical Electrophysiology
J Fedida, T Strisciuglio, M Sohal, M Wolf, K Van Beeumen, A Neyrinck, P Taghji, C Lepiece, A Almorad, Y Vandekerckhove, R Tavernier, M Duytschaever, S Knecht
PURPOSE: Catheter ablation is an effective treatment for premature ventricular complexes (PVCs). Activation mapping is accurate but requires PVCs at the time of the ablation. Pace-mapping correlation (PMC) is a supplemental tool recently developed as an integrated module for an electro-anatomical mapping platform. Our study sought to investigate whether pace-mapping technology provides similar ablation results in patients with low versus high idiopathic PVC burden at the time of ablation and the relationship between sites with the highest PMC and the earliest local activation time (LAT)...
February 24, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Clara Stegmann, Cosima Jahnke, Ingo Paetsch, Sebastian Hilbert, Arash Arya, Andreas Bollmann, Gerhard Hindricks, Philipp Sommer
Aims: Presence of late gadolinium enhancement (LGE) is related to adverse cardiovascular outcome. Many patients suffering from atrial fibrillation (AF) undergo cardiovascular magnetic resonance (CMR) imaging prior to ablation. Since quantification of atrial fibrosis still lacks reproducibility, we sought to investigate risk factors for the presence of left ventricular (LV)-LGE and a possible correlation between ventricular fibrosis as defined by positive LGE and pathological atrial voltage maps evaluated by 3D mapping systems...
February 6, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Ayman Mortada, Saeed Khaled, Samir Wafa, Hayam Eldamanhoury, Ahmed Nabil
Background: Pulmonary vein electrical isolation (PVI) is an effective treatment for atrial fibrillation (AF). However, recurrence of pulmonary vein (PV) conduction after ablation may limit long-term success. Early identification and treatment of acute PV conduction recovery during initial ablation may have an impact on subsequent clinical results. Objective: To assess the prevalence of acute PV conduction recovery during the observation time after PV isolation for paroxysmal AF, and to evaluate the impact of re-isolation treatment on long-term clinical results...
April 2017: Journal of Atrial Fibrillation
Avishag Laish-Farkash, Mahmoud Suleiman
Pulmonary vein isolation (PVI) has become the mainstay of therapy for atrial fibrillation (AF) and one of the most frequently performed procedures in the cardiac electrophysiology laboratory. PVI by a single-tip radiofrequency (RF) ablation catheter remains a complex and time-consuming procedure, especially in centers with limited experience. In order to simplify the PVI procedure, to shorten it and reduce the complication rate, circular multi-electrode catheters were introduced for simultaneous mapping and ablation...
April 2017: Journal of Atrial Fibrillation
David Soto Iglesias, Nicolas Duchateau, Constantine Butakoff Kostantyn Butakov, David Andreu, Juan Fernandez-Armenta, Bart Bijnens, Antonio Berruezo, Marta Sitges, Oscar Camara
Electro-anatomical maps (EAMs) are commonly acquired in clinical routine for guiding ablation therapies. They provide voltage and activation time information on a 3-D anatomical mesh representation, making them useful for analyzing the electrical activation patterns in specific pathologies. However, the variability between the different acquisitions and anatomies hampers the comparison between different maps. This paper presents two contributions for the analysis of electrical patterns in EAM data from biventricular surfaces of cardiac chambers...
2017: IEEE Journal of Translational Engineering in Health and Medicine
Umberto Barbero, Carlo Budano, Pier Giorgio Golzio, Davide Castagno, Fiorenzo Gaita
Implantation of cardiac resynchronization therapy (CRT) devices can be challenging, time consuming, and associated with high-dose X-Ray exposure. We present the technique in which an electromagnetic navigation system (MediGuideTM, St. Jude Medical) and an electro-anatomical three-dimensional mapping system (EnSite NavX, St Jude Medical) are usefully combined for implanting ICD-CRT devices with strong reduction of X-ray exposure, and for targeting the most delayed regions in the activation maps avoiding scars for optimal CRT response...
October 4, 2017: Pacing and Clinical Electrophysiology: PACE
Sanjay R Kharche, Edward Vigmond, Igor R Efimov, Halina Dobrzynski
AIM: The human right atrium and sinoatrial node (SAN) anatomy is complex. Optical mapping experiments suggest that the SAN is functionally insulated from atrial tissue except at discrete SAN-atrial electrical junctions called SAN exit pathways, SEPs. Additionally, histological imaging suggests the presence of a secondary pacemaker close to the SAN. We hypothesise that a) an insulating border-SEP anatomical configuration is related to SAN arrhythmia; and b) a secondary pacemaker, the paranodal area, is an alternate pacemaker but accentuates tachycardia...
2017: PloS One
Antonis S Manolis
Atrial flutter (AFlu) is usually a fast (>240 bpm) and regular right atrial macroreentrant tachycardia, with a constrained critical region of the reentry circuit located at the cavotricuspid isthmus (CTI; typical CTI-dependent AFlu). However, a variety of right and left atrial tachycardias, resulting from different mechanisms, can also present as AFlu (atypical non-CTI-dependent AFlu). The electrocardiogram can provide clues to its origin and location; however, additional entrainment and more sophisticated electroanatomical mapping techniques may be required to identify its mechanism, location, and target area for a successful ablation...
November 2017: Cardiology in Review
Shailendra Upadhyay, Edward P Walsh, Frank Cecchin, John K Triedman, Juan Villafane, J Philip Saul
BACKGROUND: Experience with percutaneous epicardial ablation of tachyarrhythmia in pediatrics is limited. This case series addresses the feasibility, safety, and complications of the procedure in children. METHODS: A total of nine patients underwent 10 epicardial ablation procedures from 2002 to 2013 at two academic centers. Activation mapping was performed in all cases, and electroanatomic map was utilized in nine of the 10 procedures. Patients had undergone one to three failed endocardial catheter ablations in addition to medical management, and all had symptoms, a high-risk accessory pathway (AP), aborted cardiac arrest with Wolff-Parkinson-White syndrome (WPW), or ventricular dysfunction...
July 26, 2017: Pacing and Clinical Electrophysiology: PACE
Nebojša Mujović, Milan Marinković, Radoslaw Lenarczyk, Roland Tilz, Tatjana S Potpara
Catheter ablation (CA) of atrial fibrillation (AF) is currently one of the most commonly performed electrophysiology procedures. Ablation of paroxysmal AF is based on the elimination of triggers by pulmonary vein isolation (PVI), while different strategies for additional AF substrate modification on top of PVI have been proposed for ablation of persistent AF. Nowadays, various technologies for AF ablation are available. The radiofrequency point-by-point ablation navigated by electro-anatomical mapping system and cryo-balloon technology are comparable in terms of the efficacy and safety of the PVI procedure...
August 2017: Advances in Therapy
Uyên Châu Nguyên, Francesco Maffessanti, Masih Mafi-Rad, Giulio Conte, Stef Zeemering, François Regoli, Maria Luce Caputo, Antonius M W van Stipdonk, Sebastiaan C A M Bekkers, Daniel Suerder, Tiziano Moccetti, Rolf Krause, Frits W Prinzen, Kevin Vernooy, Angelo Auricchio
BACKGROUND: Validation of voltage-based scar delineation has been limited to small populations using mainly endocardial measurements. The aim of this study is to compare unipolar voltage amplitudes (UnipV) with scar on delayed enhancement cardiac magnetic resonance imaging (DE-CMR). METHODS: Heart failure patients who underwent DE-CMR and electro-anatomic mapping were included. Thirty-three endocardial mapped patients and 27 epicardial mapped patients were investigated...
2017: PloS One
Karol Deutsch, Janusz Śledź, Mariusz Mazij, Bartosz Ludwik, Michał Labus, Dariusz Karbarz, Bernadetta Pasicka, Michał Chrabąszcz, Arkadiusz Śledź, Monika Klank-Szafran, Laura Vitali-Sendoz, Tomasz Kameczura, Jerzy Śpikowski, Piotr Stec, Marek Ujda, Sebastian Stec
Radiofrequency catheter ablation (RFCA) is an established effective method for the treatment of typical cavo-tricuspid isthmus (CTI)-dependent atrial flutter (AFL). The introduction of 3-dimensional electro-anatomic systems enables RFCA without fluoroscopy (No-X-Ray [NXR]). The aim of this study was to evaluate the feasibility and effectiveness of CTI RFCA during implementation of the NXR approach and the maximum voltage-guided (MVG) technique for ablation of AFL.Data were obtained from prospective standardized multicenter ablation registry...
June 2017: Medicine (Baltimore)
Ji Hyun Lee, Jun Kim, Minsu Kim, Jongmin Hwang, You Mi Hwang, Joon-Won Kang, Gi-Byoung Nam, Kee-Joon Choi, You-Ho Kim
Despite the technological advance in 3-dimensional (3D) mapping, radiation exposure during catheter ablation of atrial fibrillation (AF) continues to be a major concern in both patients and physicians. Previous studies reported substantial radiation exposure (7369-8690 cGy cm) during AF catheter ablation with fluoroscopic settings of 7.5 frames per second (FPS) under 3D mapping system guidance. We evaluated the efficacy and safety of a low-frame-rate fluoroscopy protocol for catheter ablation for AF.Retrospective analysis of data on 133 patients who underwent AF catheter ablation with 3-D electro-anatomic mapping at our institute from January 2014 to May 2015 was performed...
June 2017: Medicine (Baltimore)
Juan Lacalzada-Almeida, Javier García-Niebla
In the last twenty years, new imaging techniques to assess atrial function and to predict the risk of recurrence of atrial fibrillation after treatment have been developed. The present review deals with the role of these techniques in the detection of structural and functional changes of the atrium and diagnosis of atrial remodeling, particularly atrial fibrosis. Echocardiography allows the detection of anatomical, functional changes and deformation of the atrial wall during the phases of the cardiac cycle...
March 2017: Journal of Geriatric Cardiology: JGC
Minh B Nguyen, Scott R Ceresnak, Christopher M Janson, Steven B Fishberger, Barry A Love, Andrew D Blaufox, Kara S Motonaga, Anne M Dubin, Lynn Nappo, Robert H Pass
BACKGROUND: Ablation within the aortic cusp is safe and effective in adults. There are little data on aortic cusp ablation in the pediatric literature. We investigated the safety and efficacy of aortic cusp ablation in young patients. METHODS: A retrospective, descriptive study of aortic cusp ablation in five pediatric electrophysiology centers from 2008 to 2014 was performed. All patients <21 years of age who underwent ablation in the aortic cusps were included...
June 1, 2017: Pacing and Clinical Electrophysiology: PACE
Francesco Santoro, Christian H Heeger, Andreas Metzner, Natale D Brunetti, Matteo DI Biase, Karl-Heinz Kuck, Feifan Ouyang
INTRODUCTION: Catheter ablation (CA) is an established and widespread treatment option for drug refractory atrial fibrillation (AF). CA has undergone considerable improvements during the last years and several ablation strategies have been proposed for different AF patterns. EVIDENCE ACQUISITION: The main cornerstone is the electrical isolation of pulmonary veins (PVs) especially among patients with paroxysmal AF. This can be achieved mainly with the use of radiofrequency or cryo-energy...
May 25, 2017: Minerva Cardioangiologica
Daniele Muser, Jackson J Liang, Pasquale Santangeli
Sudden cardiac death due to ventricular tachycardia (VT) is a major health issue in patients with structural heart disease and depressed ejection fraction. If from one side, implantable cardioverter defibrillator (ICD) therapy has significantly improved survival of these patients, on the other hand, it has led to frequent ICD shocks as an emerging problem, being associated with poor quality of life, frequent hospitalizations and increased mortality. Scar-related re-entry due to the coexistence of surviving myocardial fibers within fibrotic tissue is the most common mechanism subtending VT both in ischemic and non-ischemic cardiomyopathies...
August 2017: Minerva Cardioangiologica
Lixia Shu, Jin Wang, Deyong Long, Changyan Lin
BACKGROUND: Electro-anatomical maps (EAM) and CT surface registration are widely used for catheter navigation in atrial fibrillation ablations. However, few studies have investigated the registration algorithm. Moreover, some of them are semiautomatic, so that physicians must be proficient; some are inaccurate for catheter navigation. A both automatic and accurate registration method is needed. METHOD: A Hausdorff distance based approach (HD) was proposed for EAM/CT registration...
December 2017: International Journal of Medical Robotics + Computer Assisted Surgery: MRCAS
Domenico D'Amario, Antonio Maria Leone, Maria Lucia Narducci, Costantino Smaldone, Dalgisio Lecis, Frediano Inzani, Marco Luciani, Andrea Siracusano, Federica La Neve, Melissa Manchi, Gemma Pelargonio, Francesco Perna, Piergiorgio Bruno, Massimo Massetti, Dario Pitocco, Donato Cappetta, Grazia Esposito, Konrad Urbanek, Antonella De Angelis, Francesco Rossi, Roberto Piacentini, Giulia Angelini, Domenica Donatella Li Puma, Claudio Grassi, Elisa De Paolis, Ettore Capoluongo, Valentina Silvestri, Biagio Merlino, Riccardo Marano, Filippo Crea
AIMS: In the present study, we aimed to develop a percutaneous approach and a reproducible methodology for the isolation and expansion of Cardiac Progenitor Cells (CPCs) from EndoMyocardial Biopsies (EMB) in vivo. Moreover, in an animal model of non-ischemic heart failure (HF), we would like to test whether CPCs obtained by this methodology may engraft the myocardium and differentiate. METHODS AND RESULTS: EMB were obtained using a preformed sheath and a disposable bioptome, advanced via right femoral vein in 12 healthy mini pigs, to the right ventricle...
March 1, 2017: International Journal of Cardiology
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