Minielectrode catheter technology for near zero-fluoroscopy substrate-guided ablation of typical atrial flutter
Background: MicroFidelity catheter technology may facilitate voltage-guided ablation by high-resolution electroanatomic mapping (HR-EAM) and precisely targeted energy application. Objective: To evaluate the performance of minielectrode (ME) technology for zero-fluoroscopy substrate-guided cavotricus...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-06-01
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| Series: | Heart Rhythm O2 |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666501821000775 |
| _version_ | 1819096943795634176 |
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| author | Johanna Betz, MD Laura Vitali-Serdoz, MD Veronica Buia, MD Janusch Walaschek, MD Harald Rittger, MD Dirk Bastian, MD |
| author_facet | Johanna Betz, MD Laura Vitali-Serdoz, MD Veronica Buia, MD Janusch Walaschek, MD Harald Rittger, MD Dirk Bastian, MD |
| author_sort | Johanna Betz, MD |
| collection | DOAJ |
| description | Background: MicroFidelity catheter technology may facilitate voltage-guided ablation by high-resolution electroanatomic mapping (HR-EAM) and precisely targeted energy application. Objective: To evaluate the performance of minielectrode (ME) technology for zero-fluoroscopy substrate-guided cavotricuspid isthmus (CTI) ablation. Methods: Eighty-two patients underwent near zero-fluoroscopy substrate-guided CTI ablation using a nonirrigated large-tip catheter with 3 MEs. The CTI was subdivided into 15 electroanatomic segments. Bipolar voltage maps were compared with ME signals. The outcome was compared with a historic cohort of 92 patients who underwent linear ablation. Results: Compared with linear ablation, the substrate-guided approach was associated with an almost halved ablation duration (336 ± 228 vs 649 ± 409 seconds, P < .001), halved radiofrequency energy applied (14.2 ± 10.6 vs 28.6 ± 19.6 kJ, P < .001), and shorter procedure duration (60.8 ± 33.8 vs 76.3 ± 40.9 minutes, P = .008) limiting the extent of energy delivery to 22.7% of the CTI area. HR-EAM visualized 2.03 ± 0.88 conductive pathways with a diameter of 5.35 ± 1.98 mm. A higher number of ME-detected bundles and a larger channel diameter correlated with increased ablation requirements. In 97.6% of the voltage-guided and 88.0% of the linear procedures, fluoroscopy was not used. Conclusion: HR-EAM-based substrate-guided CTI ablation may improve procedural outcome compared with the linear approach. Enhanced identification of discrete conductive pathways correlates with ablation efficacy. The electroanatomic subdivision of the CTI into 15 segments was feasible and may improve the understanding and comparability of anatomic variants and ablation results. Independent of the ablation strategy, modern EAM technology enables safe zero-fluoroscopy procedures in the majority of cases. |
| first_indexed | 2024-12-22T00:07:14Z |
| format | Article |
| id | doaj.art-bc279e9c18954c259a44ade49c1bf7a6 |
| institution | Directory Open Access Journal |
| issn | 2666-5018 |
| language | English |
| last_indexed | 2024-12-22T00:07:14Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heart Rhythm O2 |
| spelling | doaj.art-bc279e9c18954c259a44ade49c1bf7a62022-12-21T18:45:33ZengElsevierHeart Rhythm O22666-50182021-06-0123262270Minielectrode catheter technology for near zero-fluoroscopy substrate-guided ablation of typical atrial flutterJohanna Betz, MD0Laura Vitali-Serdoz, MD1Veronica Buia, MD2Janusch Walaschek, MD3Harald Rittger, MD4Dirk Bastian, MD5Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nuernberg (FAU), Erlangen, Germany; Address reprint requests and correspondence: Ms Johanna Betz, Klinikum Fürth, Jacob-Henle-Str. 1, 90766 Fürth, Germany.Department for Cardiology, Klinikum Fuerth, Teaching Hospital of Erlangen-Nuernberg University, Fuerth, GermanyDepartment for Cardiology, Klinikum Fuerth, Teaching Hospital of Erlangen-Nuernberg University, Fuerth, GermanyDepartment for Cardiology, Klinikum Fuerth, Teaching Hospital of Erlangen-Nuernberg University, Fuerth, GermanyDepartment for Cardiology, Klinikum Fuerth, Teaching Hospital of Erlangen-Nuernberg University, Fuerth, GermanyDepartment for Cardiology, Klinikum Fuerth, Teaching Hospital of Erlangen-Nuernberg University, Fuerth, GermanyBackground: MicroFidelity catheter technology may facilitate voltage-guided ablation by high-resolution electroanatomic mapping (HR-EAM) and precisely targeted energy application. Objective: To evaluate the performance of minielectrode (ME) technology for zero-fluoroscopy substrate-guided cavotricuspid isthmus (CTI) ablation. Methods: Eighty-two patients underwent near zero-fluoroscopy substrate-guided CTI ablation using a nonirrigated large-tip catheter with 3 MEs. The CTI was subdivided into 15 electroanatomic segments. Bipolar voltage maps were compared with ME signals. The outcome was compared with a historic cohort of 92 patients who underwent linear ablation. Results: Compared with linear ablation, the substrate-guided approach was associated with an almost halved ablation duration (336 ± 228 vs 649 ± 409 seconds, P < .001), halved radiofrequency energy applied (14.2 ± 10.6 vs 28.6 ± 19.6 kJ, P < .001), and shorter procedure duration (60.8 ± 33.8 vs 76.3 ± 40.9 minutes, P = .008) limiting the extent of energy delivery to 22.7% of the CTI area. HR-EAM visualized 2.03 ± 0.88 conductive pathways with a diameter of 5.35 ± 1.98 mm. A higher number of ME-detected bundles and a larger channel diameter correlated with increased ablation requirements. In 97.6% of the voltage-guided and 88.0% of the linear procedures, fluoroscopy was not used. Conclusion: HR-EAM-based substrate-guided CTI ablation may improve procedural outcome compared with the linear approach. Enhanced identification of discrete conductive pathways correlates with ablation efficacy. The electroanatomic subdivision of the CTI into 15 segments was feasible and may improve the understanding and comparability of anatomic variants and ablation results. Independent of the ablation strategy, modern EAM technology enables safe zero-fluoroscopy procedures in the majority of cases.http://www.sciencedirect.com/science/article/pii/S2666501821000775Atrial flutterCatheter ablationElectroanatomic mappingMaximum voltage-guidedZero fluoroscopy |
| spellingShingle | Johanna Betz, MD Laura Vitali-Serdoz, MD Veronica Buia, MD Janusch Walaschek, MD Harald Rittger, MD Dirk Bastian, MD Minielectrode catheter technology for near zero-fluoroscopy substrate-guided ablation of typical atrial flutter Heart Rhythm O2 Atrial flutter Catheter ablation Electroanatomic mapping Maximum voltage-guided Zero fluoroscopy |
| title | Minielectrode catheter technology for near zero-fluoroscopy substrate-guided ablation of typical atrial flutter |
| title_full | Minielectrode catheter technology for near zero-fluoroscopy substrate-guided ablation of typical atrial flutter |
| title_fullStr | Minielectrode catheter technology for near zero-fluoroscopy substrate-guided ablation of typical atrial flutter |
| title_full_unstemmed | Minielectrode catheter technology for near zero-fluoroscopy substrate-guided ablation of typical atrial flutter |
| title_short | Minielectrode catheter technology for near zero-fluoroscopy substrate-guided ablation of typical atrial flutter |
| title_sort | minielectrode catheter technology for near zero fluoroscopy substrate guided ablation of typical atrial flutter |
| topic | Atrial flutter Catheter ablation Electroanatomic mapping Maximum voltage-guided Zero fluoroscopy |
| url | http://www.sciencedirect.com/science/article/pii/S2666501821000775 |
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