Initial Experience Using AutoMark in Atrial Fibrillation Ablation

Abstract

Background: EnSite Precision AutoMark Module (Abbott) refers to automated lesion creating tool. Only lesions meeting user-defined requirements are placed on the map. The amount of ablation is represented by the size and color of marking spheres. The aim of this study is to present our initial experience with AutoMark Module in AF ablation. Methods: Nine patients with AF underwent electroanatomic mapping and radiofrequency ablation (RF) using Au-toMark Module for marking RF lesions. Pulmonary vein isolation was performed in all patients. Cavo tricuspid isthmus ablation was done in 3 patients with atrial flutter. Lesions were marked in different colors depending on force-time integral, absolute impedance drop and RF duration as follows: white (<50 g; <6 Ω; < 5 s); yellow (50-150 g; 6-8 Ω; 5-15 s); orange (150-300 g; 8-10 Ω; 15-30 s); red (>300 g; >10 Ω; >30 s). An auto-mark was created when catheter remained in a stable location for more than 3 s, with a minimum distance between spheres (center-to-center) of 3 mm. Auto-marks were compared with manually placed spheres. 24-hour Holter ECG monitoring was performed regularly until the end of the follow-up. Results: Nine patients (mean age of 53 ± 10 years, 3 male) were included in the study with EHRA class 2b (44%) and class 3 (56%). Auto-marks were placed only when user-defined criteria were reached whereas manual points were marked subjectively. The auto-marks numbered 299 ± 82 per procedure and 5.39 ± 1.42 per RF application. Automarks provided good visualization of the ablation lines using the predefined criteria. AutoMark Module visualized probable gaps in the ablation line, which appeared as an area without spheres or with white spheres. That was not possible with manual marking because of its subjective nature. Conclusion: AutoMark is better than manual marking in providing real-time visual feedback on lesion creation. Our preselected lesion parameters ensure a tool to visualize possible gaps in the ablation line.

Standard versus strict stability criteria in radiofrequency paroxysmal atrial fibrillation ablation using ablation index

“…Automated lesion tagging systems such as VISITAG, AUTOMARK (Abbott, Abbott Park, Illinois, USA) or RHYTHMIA HDx (Boston Scientific, Inc., Marlborough, Massachusetts, USA) have a pivotal role to display, even in real time, the RF delivery location and the distance from the closest or the last lesion 17 ; this, together with the use of standard stability criteria (necessary for a rapid tag pop‐up) can lead to overall effective, safe and sleek procedures. This becomes even more important given the recent experiences in the growing field of high‐power short‐duration ablation techniques 18–21 …”