Novel noncontact charge density map in the setting of post-atrial fibrillation atrial tachycardias: first experience wit
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Novel noncontact charge density map in the setting of post-atrial fibrillation atrial tachycardias: first experience with the Acutus SuperMap Algorithm Robbert Ramak 1 & Gian-Battista Chierchia 1 & Gaetano Paparella 1 & Cinzia Monaco 1 & Vincenzo Miraglia 1 & Federico Cecchini 1 & Antonio Bisignani 1 & Joerelle Mojica 1 & Maysam Al Housari 1 & Dimitrios Sofianos 1 & Shuichiro Kazawa 1 & Ingrid Overeinder 1 & Gezim Bala 1 & Erwin Ströker 1 & Juan Sieira 1 & Thiago Guimaraes Osorio 1 & Pedro Brugada 1 & Carlo de Asmundis 1 Received: 14 May 2020 / Accepted: 22 June 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The purpose of this study was to evaluate the safety and feasibility of the new high-resolution mapping algorithm SuperMap (Acutus Medical, CA, USA) in identifying and guiding ablation in the setting of regular atrial tachycardias following index atrial fibrillation (AF) ablation. Methods Seven consecutive patients who underwent a radiofrequency catheter ablation guided by the novel noncontact charge density (CD) SuperMap for atrial tachycardia were prospectively enrolled in our study. Results Arrhythmogenic substrate was identified in all seven patients. Mean number of EGM per map was 5859.7 ± 4348.5 points. Three patients (43%) exhibited focal tachycardia mechanisms in the left atrium, alternating from anteroseptal right superior pulmonary vein (RSPV), posterior in proximity of left inferior pulmonary vein (LIPV), and interarial septum in proximity of fossa ovalis, respectively. Four patients exhibited macroreentrant mechanism. In 3 of these patients, SuperMap detected mitral isthmus-dependent flutters with tachycardia cycle lengths of 240, 270 and 420 ms, respectively. In one patient, the mechanism was a macroreentrant tachycardia with the critical isthmus located between the crista terminalis and atriotomy. The mean ablation time (min) was 18.2 ± 12.5 and the mean procedural duration time was 56.4 ± 12.1 min. No minor or major complications occurred. Conclusion The novel high-resolution mapping algorithm SuperMap proved to be safe, fast, and feasible in identifying and guiding ablation in the setting of regular atrial tachycardias following index AF ablation. Keywords SuperMap algorithm . Dipole density noncontact mapping . Unipolar signals . Atrial tachycardia . Contact force ablation . LSI
1 Introduction Atrial tachycardias (AT) can be observed following ablation of atrial fibrillation (AF) in 5–25% of cases [1–4]. The underlying mechanisms comprise focal AT, micro re-entry, and more often Robbert Ramak and Gian-Battista Chierchia contributed equally to the article as first authors. * Gian-Battista Chierchia [email protected] 1
Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
macro re-entrant circuits [5]. Although three-dimensional (3D) mapping is of grea
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