Combined Use of a High-Density Multi-electrode Mapping Catheter and a Magnetically Navigated Ablation Catheter for Atrial Fibrillation Procedures: A Feasibility Study

Abstract

ABSTRACT. PentaRays catheters (Biosense Webster, Diamond Bar, CA) create high-density electroanatomical maps, and remote magnetic navigation (RMN) (Niobe Epocht, Stereotaxis Inc., St. Louis, MO) enables intricate manipulation of magnetic ablation catheters. The purpose of this study was to assess the feasibility of PentaRay s used in combination with RMN ablation for pulmonary vein isolation (PVI). In 21 paroxysmal atrial fibrillation (AF) patients undergoing PVI, a PentaRay s catheter was used to map the left atrium in sinus rhythm at baseline and post PVI. The Navigant Ablation History module (Stereotaxis Inc., St. Louis, MO) was used to help create connected ablation lines, pacing from the ablation catheter (ThermoCool RMT, Biosense Webster, Diamond Bar, CA) was performed to examine the presence of exit block, and voltage maps from the PentaRay s were used to demarcate low-voltage areas where bipolar voltages were within 0.25-0.5 mV. This information was assessed to identify potential PVI gaps, and additional ablation points were delivered as necessary. Complete PVI was achieved in 21 out of 21 patients (100%). The average initial mapping time was 12.4 ± 2.7 min spanning 1,726 ± 476 points. Similarly, the average remap time was 14 ± 4.3 min spanning 1,928 ± 842 points. There were no procedural complications associated with this study. This study demonstrates the feasibility of this clinical workflow using both a high-density multi-electrode mapping catheter and an RMN ablation catheter for PVI. The combination might be a useful strategic choice for treatment of AF.