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Noncontact Mapping‐Guided Ablation of Atrial Flutter and Enhanced‐Density Mapping of the Inferior Vena Caval‐Tricuspid Annulus Isthmus
Author(s) -
SCHNEIDER MICHAEL A.E.,
NDREPEPA GJIN,
ZRENNER BERNHARD,
KARCH MARTIN R.,
SCHMIEDER SEBASTIAN,
DEISENHOFER ISABEL,
SCHREIECK JÜRGEN,
SCHÖMIG ALBERT,
SCHMITT CLAUS
Publication year - 2001
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2001.01755.x
Subject(s) - atrial flutter , medicine , ablation , inferior vena cava , flutter , cardiology , catheter ablation , radiofrequency ablation , reentry , atrial fibrillation , anatomy , engineering , aerodynamics , aerospace engineering
SCHNEIDER, M.A.E., et al. : Noncontact Mapping‐Guided Ablation of Atrial Flutter and Enhanced‐Density Mapping of the Inferior Vena Caval‐Tricuspid Annulus Isthmus. Three‐dimensional visualization of cardiac activation has become important in providing further insights into pathophysiological mechanisms of arrhythmias and to increase the efficacy of catheter ablation. The noncontact mapping enables a single beat analysis in a reconstructed geometry of the cardiac chamber. The aim of the study was to describe three‐dimensional activation patterns and inferior vena caval‐tricuspid annulus (IVC‐TA) isthmus conduction characteristics in patients with atrial flutter and the noncontact guidance of the radiofrequency ablation of this arrhythmia. In 34 patients with atrial flutter, the noncontact probe was deployed in the RA. The global three‐dimensional activation and the isthmus conduction (enhanced density mapping) were delineated during ongoing atrial flutter and paced rhythms. Ablation was performed nonfluoroscopically based on reconstructed anatomy and conduction patterns. Noncontact mapping was compared and validated with conventional multielectrode technique. IVC‐TA isthmus ablation was completed successfully in 33 (97%) of 34 patients. In one patient a lower loop reentry around the inferior vena cava was depicted as a mechanism of atrial flutter. In another patient with positive flutter waves in inferior leads, an activation pattern typical of counterclockwise flutter was demonstrated in propagation maps. During a follow‐up of 15.9 ± 5.9 months, two atrial flutter recurrences occurred (5.8%). A gap of the resumed conduction through the IVC‐TA isthmus was delineated as a mechanism of recurrence and ablated with one and three radiofrequency applications. Noncontact mapping allows construction of the global activation patterns in typical and atypical atrial flutter. It enables the nonfluoroscopic guidance of atrial flutter ablation and a comprehensive evaluation of the ablation results.