High-Resolution Mapping of Ventricular Scar

Leshem, Eran; Tschabrunn, Cory M.; Jang, Jihye; Whitaker, John; Zilberman, Israel; Beeckler, Christopher; Govari, Assaf; Kautzner, Josef; Peichl, Petr; Nezafat, Reza; Anter, Elad

doi:10.1016/j.jacep.2016.12.016

Cited by 48 publications

(22 citation statements)

References 14 publications

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“…A novel CF-sensing catheter (QDOT Micro, Biosense Webster, Inc. Diamond Bar, CA, USA) has been developed allowing real-time assessment of catheter-to-tissue interface temperature and therefore temperature-controlled ablation. This catheter incorporates three microelectrodes and six thermocouples at its tip for precise temperature monitoring [12] , [13] . In the very high-power short-duration mode (vHP-SD, 90 W/4 s, QMODE+) only power is adapted to adjust the target temperature [14] .…”

Section: Introductionmentioning

confidence: 99%

Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study

Tilz

Sano

Vogler

et al. 2021

IJC Heart & Vasculature

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Background Catheter ablation for atrial fibrillation (AF) treatment provides effective and durable pulmonary vein isolation (PVI) and is associated with encouraging clinical outcome. A novel CF sensing temperature-controlled radiofrequency (RF) ablation catheter allows for very high-power short-duration (vHP-SD, 90 W/4 s) ablation aiming a potentially safer, more effective and faster ablation. We thought to evaluate preliminary safety and efficacy of vHP-SD ablation for PVI utilizing a novel vHP-SD catheter. The data was compared to conventional power-controlled ablation index (AI) guided PVI utilizing conventional contact force (CF) sensing catheters. Methods and Results Fifty-six patients with paroxysmal or persistent AF were prospectively enrolled in this study. Twenty-eight consecutive patients underwent vHP-SD based PVI (vHP-SD group) and were compared to 28 consecutive patients treated with conventional CF-sensing catheters utilizing the AI (control group). All PVs were successfully isolated using vHP-SD. The median RF ablation time for vHP-SD was 338 (IQR 286, 367) seconds vs control 1580 (IQR 1350, 1848) seconds (p < 0.0001), the median procedure duration was vHP-SD 55 (IQR 48–60) minutes vs. control 105 (IQR 92–120) minutes (p < 0.0001). No differences in periprocedural complications were observed. Conclusions This preliminary data of the novel vHP-SD ablation mode provides safe and effective PVI. Procedure duration and RF ablation time were substantially shorter in the vHP-SD group in comparison to the control group.

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Section: Introductionmentioning

confidence: 99%

Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study

Tilz

Sano

Vogler

et al. 2021

IJC Heart & Vasculature

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“…In the present study, these improvements were seen when CV was calculated in 1 and 2 dimensions from these LAT differences using a finite difference and a triangulation method, respectively. Notably, the latter can be clinically implemented with newer catheters with triads of closely spaced microelectrodes (Leshem et al, 2017;Sulkin et al, 2018), theoretically allowing local CV measurement with each individual point acquisition given sufficient temporal resolution. Importantly, given the scale-dependence of CV, measurement at macroscopic distances will differ from that measured at the smallest scales.…”

Section: Discussionmentioning

confidence: 99%

High-Resolution Measurement of Local Activation Time Differences From Bipolar Electrogram Amplitude

2021

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Localized changes in myocardial conduction velocity (CV) are pro-arrhythmic, but high-resolution mapping of local CV is not yet possible during clinical electrophysiology procedures. This is in part because measurement of local CV at small spatial scales (1 mm) requires accurate annotation of local activation time (LAT) differences with very high temporal resolution (≤1 ms), beyond that of standard clinical methods. We sought to develop a method for high-resolution measurement of LAT differences and validate against existing techniques. First, we use a simplified theoretical model to identify a quantitative relationship between the LAT difference of a pair of electrodes and the peak amplitude of the bipolar EGM measured between them. This allows LAT differences to be calculated from bipolar EGM peak amplitude, by a novel “Determination of EGM Latencies by Transformation of Amplitude” (DELTA) method. Next, we use simulated EGMs from a computational model to validate this method. With 1 kHz sampling, LAT differences less than 4 ms were more accurately measured with DELTA than by standard LAT annotation (mean error 3.8% vs. 22.9%). In a 1-dimensional and a 2-dimension model, CV calculations were more accurate using LAT differences found by the DELTA method than by standard LAT annotation (by unipolar dV/dt timing). DELTA-derived LAT differences were more accurate than standard LAT annotation in simulated complex fractionated EGMs from a model incorporating fibrosis. Finally, we validated the DELTA method in vivo using 18,740 bipolar EGMs recorded from the left atrium of 10 atrial fibrillation patients undergoing catheter ablation. Using clinical EGMs, there was agreement in LAT differences found by DELTA, standard LAT annotation, and unipolar waveform cross-correlation. These results demonstrate an underlying relationship between a bipolar EGM’s peak amplitude and the activation time difference between its two electrodes. Our computational modeling and clinical results suggest this relationship can be leveraged clinically to improve measurement accuracy for small LAT differences, which may improve CV measurement at small spatial scales.

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“…Only points with adequate cathetertissue contact (>3 g) were acquired; for each point, the system automatically acquired the standard bipolar electrogram and the microbipolar electrogram with the highest amplitude, to correct for wavefront propagation direction. [4][5][6] Operators were also allowed to use a multipolar catheter with 5 splines, each with 4 1 mm wide electrodes with 2-6-2 mm spacing (PentaRay; Biosense Webster), recording bipolar electrograms between each 2 mm spaced electrogram pair (minibipolar electrograms). Catheter-tissue contact was verified with fluoroscopy, signal characteristics, and ICE, and points acquired with the PentaRay catheter were filtered using the tissue DELLO RUSSO ET AL.…”

Section: Electroanatomical Mapping and Electrophysiology Studymentioning

confidence: 99%

“…14,15 Even more recent reports on the correlation between electrogram voltage and myocardial fibrosis, as assessed by whole heart histology 16 or cardiac magnetic resonance imaging, 17 are limited by the use of conventional mapping catheters with 3.5 mm tip electrode, 1 mm ring electrode, and 2 mm interelectrode spacing. 16,17 Accumulating evidence is supporting the concept that using smaller electrodes may allow the detection of higher amplitude signals, [4][5][6] which may translate into the need to dynamically adjust voltage cutoffs in microelectrode maps, 4,5 but the clinical impact of this phenomenon has not been quantified in humans and needs to be investigated further. In fact, all data regarding substrate-based ablation for VT have been acquired with a standard bipolar configuration, and we cannot exclude that microbipolar mapping may have a deep impact on the procedural approach to substrate homogenization, pushing operators toward less extensive ablation lesions sets directed to more limited regions of interest.…”

Section: Conventional Electrodes Minielectrodes Microelectrodes and T...mentioning

confidence: 99%

“…3 In studies involving swine models of myocardial infarction, microelectrode voltage mapping was shown to have superior sensitivity for the detection of viable myocardium compared to standard bipolar mapping. [4][5][6] As of today, however, we are lacking information on the clinical value of microelectrode voltage mapping among human subjects undergoing CA for VT. The aim of the present study is to report on the preliminary clinical experience with microelectrode mapping as compared to standard bipolar mapping in the setting of VT CA.…”

Section: Introductionmentioning

confidence: 99%

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Microelectrode voltage mapping for substrate assessment in catheter ablation of ventricular tachycardia: A dual‐center experience

Russo

Compagnucci

Bergonti

et al. 2023

Cardiovasc electrophysiol

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Introduction:The assessment of the ventricular myocardial substrate critically depends on the size of mapping electrodes, their orientation with respect to wavefront propagation, and interelectrode distance. We conducted a dual-center study to evaluate the impact of microelectrode mapping in patients undergoing catheter ablation (CA) of ventricular tachycardia (VT).Methods: We included 21 consecutive patients (median age, 68 [12], 95% male) with structural heart disease undergoing CA for electrical storm (n = 14) or recurrent VT (n = 7) using the QDOT Micro catheter and a multipolar catheter (PentaRay, n = 9).The associations of peak-to-peak maximum standard bipolar (BV c ) and minibipolar (PentaRay, BV p ) with microbipolar (BV μMax ) voltages were respectively tested in sinus rhythm with mixed effect models. Furthermore, we compared the features of standard bipolar (BE) and microbipolar (μBE) electrograms in sinus rhythm at sites of termination with radiofrequency energy.Results: BV μMax was moderately associated with both BV c (β = .85, p < .01) and BV p (β = .56, p < .01). BV μMax was 0.98 (95% CI: 0.93−1.04, p < .01) mV larger than corresponding BV c , and 0.27 (95% CI: 0.16−0.37, p < .01) mV larger than matching BVp in sinus rhythm, with higher percentage differences in low voltage regions, leading to smaller endocardial dense scar (2.3 [2.7] vs. 12.1 [17] cm 2 , p < .01) and border zone (3.2 [7.4] vs. 4.8 [20.1] cm 2 , p = .03) regions in microbipolar maps compared to standard bipolar maps. Late potentials areas were nonsignificantly greater in microelectrode maps, compared to standard electrode maps. At sites of VT

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High-Resolution Mapping of Ventricular Scar

Cited by 48 publications

References 14 publications

Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study

Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study

High-Resolution Measurement of Local Activation Time Differences From Bipolar Electrogram Amplitude

Microelectrode voltage mapping for substrate assessment in catheter ablation of ventricular tachycardia: A dual‐center experience

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