Panoramic atrial mapping with basket catheters: A quantitative analysis to optimize practice, patient selection, and catheter choice

Honarbakhsh, Shohreh; Schilling, Richard J.; Providência, Rui; Dhillon, Gurpreet; Sawhney, Vinit; Martin, Claire; Keating, Emily; Finlay, Malcolm; Ahsan, Syed; Chow, Anthony W.; Earley, Mark J.; Hunter, Ross J.

doi:10.1111/jce.13331

Cited by 24 publications

(19 citation statements)

References 14 publications

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“…LVZ were clustered in relatively large regions rather than scattered throughout the myocardium. The focal nature of this remodeling process has been observed previously 9 and enabled accurate assessment of CV dynamics within these zones. CV at 600 ms PI was reduced by about 15% in LVZ (0.2–0.5 mV) and 40% in vLVZs (0–0.2 mV) compared to non-LVZs ≥0.5 mV, suggesting that CV slows progressively with fibrosis.…”

Section: Discussionmentioning

confidence: 60%

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Structural remodeling and conduction velocity dynamics in the human left atrium: Relationship with reentrant mechanisms sustaining atrial fibrillation

et al. 2019

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Section: Discussionmentioning

confidence: 60%

“…A 64-pole basket catheter (Constellation, Boston Scientific Ltd, Natick, MA; or FIRMap, Abbott, Santa Clara, CA) was used to record unipolar signals. It was positioned in the LA to achieve the best possible atrial coverage 9 …”

Section: Methodsmentioning

confidence: 99%

Structural remodeling and conduction velocity dynamics in the human left atrium: Relationship with reentrant mechanisms sustaining atrial fibrillation

et al. 2019

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“…Sequential mapping may also allow higher density acquisition of data to identify AFDs where limited contact and electrode coverage are achieved with the basket catheter. 7 , 8 …”

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confidence: 99%

Prospective STAR-Guided Ablation in Persistent Atrial Fibrillation Using Sequential Mapping With Multipolar Catheters

Honarbakhsh

Schilling

Finlay

et al. 2020

Circ: Arrhythmia and Electrophysiology

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Background - A novel 'STAR' mapping approach to guide AF ablation using basket catheters recently showed high rates of AF termination and subsequent freedom from AF. Methods - This study aimed to determine whether STAR mapping using sequential recordings from conventional pulmonary vein mapping catheters could achieve similar results. Patients with persistent AF <2 years were included. Following pulmonary vein isolation (PVI) AF drivers (AFDs) were identified on sequential STAR maps created with PentaRay, IntellaMap Orion, or Advisor HD Grid catheters. Patients had a minimum of 10 multipolar recordings of 30-seconds each. These were processed in real-time and AFDs were targeted with ablation. An ablation response was defined as AF termination or CL slowing ≥30ms. Results - Thirty patients were included (62.4±7.8 years old, AF duration 14.1±4.3 months) of which 3 had AF terminated on PVI, leaving 27 patients that underwent STAR-guided AFD ablation. Eighty-three potential AFDs were identified (3.1±1.0 per patient) of which 70 were targeted with ablation (2.6±1.0 per patient). An ablation response was seen at 54 AFD (77.1% of AFD; 21 AF termination and 33 CL slowing) and occurred in all 27 patients. No complications occurred. At 17.3±10.1 months, 22/27 (81.5%) patients undergoing STAR guided ablation were free from AF/AT off anti-arrhythmic drugs. Conclusions - STAR-guided AFD ablation through sequential mapping with a multipolar catheter effectively achieved an ablation response in all patients. AF terminated in a majority of patients, with a high freedom from AF/AT off anti-arrhythmic drugs at long-term follow-up.

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“…The flaws seen with interspline bunching resulted in loss of coverage and contact, and only 63.1% of the interelectrode distances were less than the most stringent spatial resolution requirement for identification of rotors in human AF, calculated as 44/3.1 = 14.2 mm . The newer basket catheter, FIRMap catheter, has stiffer splines intended to minimize distortion and bunching, and improved sampling of atrial surface area . Furthermore, several high‐density mapping catheters (like Lasso and PentaRay) have interelectrode spacings less than 14.2 mm, suggesting that these catheters have higher resolution to accurately locate phase singularities (PSs) if placed over the rotor core.…”

Section: Discussionmentioning

confidence: 99%

Extra pulmonary vein driver mapping and ablation in paroxysmal atrial fibrillation by electrogram dispersion analysis

Qin

Lin

et al. 2018

Cardiovasc electrophysiol

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Background: The adjunctive approach is still unknown for atrial fibrillation (AF), which cannot be terminated after pulmonary vein isolation (PVI). We hypothesized that the driver ablation plus PVI was superior to PVI alone. Methods and Results:A total of 98 patients with paroxysmal AF were enrolled in this study and were divided into two groups, with one group undergoing PVI (n = 49) and the other group undergoing PVI + driver ablation (n = 49). The driver regions were defined as clusters of bipolar electrograms that displayed spatial dispersion spread over mean AF cycle length at a minimum of three adjacent bipolars of a PentaRay catheter. During the procedure, the most prominent driver regions before PVI were the roof (n = 27; 55.1%), PV antrum (n = 23; 46.9%), and the inferoposterior wall (n = 11; 22.4%). PVI can eliminate all drivers at PV antrum, but only terminate 30.4% of AF in the driver group. The AF termination rate in the driver ablation group was significantly higher than that in conventional ablation (93.9% vs 40.6%; P < 0.001).The rate of freedom from atrial tachyarrhythmia episodes by a single procedure at 6 months was significantly higher in the driver group than in the conventional group (91.6% vs 72.4%; P = 0.02). Conclusion:The present method is effective for AF driver identification. It guided ablation adjunctive to PVI increasing the rate of AF termination and improving the outcomes in patients with paroxysmal AF. K E Y W O R D S atrial fibrillation, driver, electrogram dispersion, mapping 1 | INTRODUCTION Pulmonary vein isolation (PVI) has been established as the recommended catheter ablation approach for atrial fibrillation (AF).However, the AF recurrence rate is as high as 40% even after a repeat procedure. 1,2 Disappointingly, the STAR-AFII trial failed to demonstrate the superiority of adjunctive ablation strategy beyond standard PVI. 3 "What is the next step after PVI?" still beset us for several years. Several meta-analyses showed that the direct AF driver-guided ablation using either endocardial or inverse computed epicardial recordings has yielded higher AF-freedom rates than standard PVI alone. 4,5 However, some studies have poor results for unclear reasons. 6,7 Recently, simulated data demonstrated that highdensity mapping catheters could accurately locate drivers. Furthermore, clinical data also showed that the regions with spatiotemporal electrogram (ECG) dispersion on multiple-electrode catheters, which are effective and efficient in driver mapping and ablation, may indicate the presence of an underlying source of AF. 8 However, that J Cardiovasc Electrophysiol. 2019;30:164-170. wileyonlinelibrary.com/journal/jce

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Panoramic atrial mapping with basket catheters: A quantitative analysis to optimize practice, patient selection, and catheter choice

Abstract: The FIRMap is superior to the Constellation catheter in terms of LA coverage and contact. Optimizing catheter position and appropriate patient selection based on no more than moderately dilated or scarred atria will also facilitate mapping with basket catheters.

Cited by 24 publications

References 14 publications

Structural remodeling and conduction velocity dynamics in the human left atrium: Relationship with reentrant mechanisms sustaining atrial fibrillation

Structural remodeling and conduction velocity dynamics in the human left atrium: Relationship with reentrant mechanisms sustaining atrial fibrillation

Prospective STAR-Guided Ablation in Persistent Atrial Fibrillation Using Sequential Mapping With Multipolar Catheters

Extra pulmonary vein driver mapping and ablation in paroxysmal atrial fibrillation by electrogram dispersion analysis

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