Recent advances in three-dimensional electroanatomical mapping guidance for the ablation of complex atrial and ventricul
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MULTIMEDIA REPORT
Recent advances in three-dimensional electroanatomical mapping guidance for the ablation of complex atrial and ventricular arrhythmias Paolo Compagnucci 1 & Giovanni Volpato 1 & Umberto Falanga 1 & Laura Cipolletta 1 & Manuel Conti 1 & Gino Grifoni 1 & Letizia Verticelli 1 & Nicolò Schicchi 2 & Andrea Giovagnoni 2,3 & Michela Casella 1,3 & Federico Guerra 1,4 & Antonio Dello Russo 1,4 Received: 26 March 2020 / Accepted: 11 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To provide a brief overview of some relevant technological advances in the field of three-dimensional electroanatomical mapping (3D-EAM) that have recently entered the clinical arena and their role in guiding catheter ablation (CA) of complex atrial and ventricular arrhythmias. Methods In this technical report, we describe the general features of three novel algorithms featured in the updated CARTO PRIME™ mapping module for CARTO®3 version 7 3D-EAM system (Biosense Webster Inc., Diamond Bar, CA, USA): local activation time (LAT) hybrid, coherent mapping and map replay modules. We also report three challenging arrhythmia cases in which CA was successfully guided by these softwares. Results The LAT hybrid module was used in a case of premature ventricular complex originating from the right coronary cusp. This algorithm facilitated safe positioning of the ablation catheter away from the right coronary ostium, avoiding potential harm to this vital structure. The coherent mapping module helped to identify the critical as well as a bystander isthmus of an atrial macro-reentrant tachycardia in a grown-up patient with congenital heart disease. The map replay module allowed rapid retrospective activation mapping of two unstable ventricular tachycardias in a case of nonischemic cocaine-associated cardiomyopathy. Conclusion 3D-EAM systems offer significant advantages in the management of challenging arrhythmias, and the introduction of novel algorithms underpins improvements in patients’ outcomes. Given the increasing sophistication of these systems, however, a close collaboration among cardiac electrophysiologists, engineers and technicians is highly needed in order to get the best from the available technology. Keywords Arrhythmias . Cardiac . Three-dimensional electroanatomical mapping . Premature ventricular complex ablation . Macro-re-entrant atrial tachycardia ablation . Atrial arrhythmias in congenital heart disease . Unstable ventricular tachycardia ablation
1 Introduction Three-dimensional electroanatomical mapping (3D-EAM) systems have become indispensable tools to guide catheter
ablation (CA) of complex arrhythmias, including premature ventricular complexes (PVCs) originating from unusual anatomic locations [1–3], scar-related atrial tachycardias (ATs) [4] and endocardial or epicardial ventricular tachycardias
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10840-020-00781-3) contains supplementary material, which is available to auth
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