Document Detail


Noncontact mapping-guided ablation of atrial flutter and enhanced-density mapping of the inferior vena caval-tricuspid annulus isthmus.
MedLine Citation:
PMID:  11817809     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Three-dimensional visualization of cardiac activation has become important in providing further insights into pathophysiological mechanisms of arrhythmias and to increase the efficacy of catheter ablation. The noncontact mapping enables a single beat analysis in a reconstructed geometry of the cardiac chamber. The aim of the study was to describe three-dimensional activation patterns and inferior vena caval-tricuspid annulus (IVC-TA) isthmus conduction characteristics in patients with atrial flutter and the noncontact guidance of the radiofrequency ablation of this arrhythmia. In 34 patients with atrial flutter, the noncontact probe was deployed in the RA. The global three-dimensional activation and the isthmus conduction (enhanced density mapping) were delineated during ongoing a trial flutter and paced rhythms. Ablation was performed nonfluoroscopically based on reconstructed anatomy and conduction patterns. Noncontact mapping was compared and validated with conventional multielectrode technique. IVC-TA isthmus ablation was completed successfully in 33 (97%) of 34 patients. In one patient a lower loop reentry around the inferior vena cava was depicted as a mechanism of atrial flutter. In another patient with positive flutter waves in inferior leads, an activation pattern typical of counterclockwise flutter was demonstrated in propagation maps. During a follow-up of 15.9 +/- 5.9 months, two atrial flutter recurrences occurred (5.8%). A gap of the resumed conduction through the IVC-TA isthmus was delineated as a mechanism of recurrence and ablated with one and three radiofrequency applications. Noncontact mapping allows construction of the global activation patterns in typical and atypical atrial flutter. It enables the nonfluoroscopic guidance of atrial flutter ablation and a comprehensive evaluation of the ablation results.
Authors:
M A Schneider; G Ndrepepa; B Zrenner; M R Karch; S Schmieder; I Deisenhofer; J Schreieck; A Schömig; C Schmitt
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  24     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2001 Dec 
Date Detail:
Created Date:  2002-01-30     Completed Date:  2002-07-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1755-64     Citation Subset:  IM    
Affiliation:
Deutsches Herzzentrum and I. Medizinische Klinik, Technische Universität München, Munich, Germany. SchneiderM@DHM.mhn.de
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MeSH Terms
Descriptor/Qualifier:
Atrial Flutter / physiopathology,  surgery*
Catheter Ablation
Female
Heart Conduction System / physiopathology
Humans
Imaging, Three-Dimensional
Male
Middle Aged
Tricuspid Valve
Vena Cava, Inferior

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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