High-Density Mapping in Ventricular Tachycardia Ablation: A PentaRay^® Study

Abstract

BackgroundHigh-density mapping of ventricular tachycardia (VT) with PentaRay® (Biosense-Webster) provides high resolution with discrimination of local abnormal electrograms and slow conducting channels. We evaluate the feasibility of PentaRay® to characterize the anatomical substrate and assume an influence of the outcome despite limitations.MethodsOver a 24-month period, 26 endocardial and four epicardial maps were obtained of 26 VT patients (18 ischemic cardiomyopathy (ICM, 69.2%) and 8 non-ischemic cardiomyopathy (NICM, 30.8%), age 65 ± 9 years). Catheter ablation (CA) was performed with the aim of transecting the isthmus. The endpoint was non-inducibility of any VT. Manual review of the maps was performed and focused on evaluating scarring, bipolar electrograms, and procedure times.ResultsIn 55.6 ± 34.4 min, 1,085.9 ± 726.2 points were created. The mean ablation time was 50.8 ± 30.1 min. The endpoint was achieved in 12 patients (46.2%). The mean dense scar area and the mean patchy scar area were 49.4 ± 51.8 cm2 (range 0 - 190 cm2) and 14.7 ± 14.9 cm2 (range 0 - 110 cm2), respectively. Analyzing the learning curve, we found a tendency in decreasing procedure times. During the course of follow-up treatment averaging a 14-month period, device interrogation showed that 17 patients (65.4%) had remained free of any arrhythmia recurrence.ConclusionThe high-density maps with PentaRay® were safely created in a short period of time. Our manual review of the maps reveals limitations of current annotation criteria; nevertheless, medium-term outcomes were encouraging. Further prospective studies are required to validate our findings in a larger cohort of patients.

Catheter ablation of ventricular arrhythmia guided by a high‐density grid catheter

“…This study is reporting on the clinical use of the HDG and BDA in catheter ablation of VAs. The study conveys the following new findings: Integration of an equally spaced grid catheter with an EAM system is safe and feasible for substrate identification in a heterogeneous group of patients with VAs. Time to create HD substrate or activation maps is similar in comparison with other MEM catheters 1,2,5,8,11,16–20 Points used and points collected differed significantly, underpinned by the BDA whereby the largest bipolar V p‐p is selected independent of depolarizing wavefront and catheter orientation.…”

Multipolar mapping with the high‐density grid catheter compared with conventional point‐by‐point mapping to guide catheter ablation for focal arrhythmias

“…Prior clinical studies have demonstrated the role of MPM catheters for the treatment of atrial and ventricular arrhythmias in the presence of structural heart disease 19–22 . However, few studies have compared multipolar with conventional PbyP mapping.…”

Successful case of complex atrial flutter occurring in a patient with congenitally corrected transposition of the great arteries, aberrant left atrial appendage, and situs inversus

“…Activation map and voltage map were created with 3156 points in right atrium and 6228 points in left atrium. Previous studies have reported the advantages and effectiveness of highdensity mapping in the mapping and ablation of complex arrhythmias [8][9][10]. It is essential to comprehensively combine activation map, voltage map and entrainments in the ablation strategy design.…”