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Diagnosis and ablation of focal right atrial tachycardia using a new high-resolution, non-contact mapping system

      Conventional electrophysiologic catheter techniques are used to identify the mechanisms and origin of cardiac tachyarrhythmias in symptomatic patients.
      • Jackman W.M.
      • Wang X.Z.
      • Friday K.J.
      • Roman C.A.
      • Moulton K.P.
      • Beckman K.J.
      • McClelland J.H.
      • Twidale N.
      • Hazlitt H.A.
      • Prior M.I.
      • et al.
      Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current.
      ,
      • Feld G.K.
      • Fleck R.P.
      • Chen P.-S.
      • Boyce K.
      • Bahnson T.D.
      • Stein J.B.
      • Calisi C.M.
      • Ibarra M.
      Radiofrequency catheter ablation for the treatment of human type 1 atrial flutter. Identification of a critical zone in the reentrant circuit by endocardial mapping techniques.
      ,
      • Kay G.N.
      • Chong F.
      • Epstein A.E.
      • Dailey S.M.
      • Plumb V.J.
      Radiofrequency ablation for treatment of primary atrial tachycardias.
      ,
      • Fischer B.
      • Jais P.
      • Shah D.
      • Chouairi S.
      • Haissaguerre M.
      • Garrigues S.
      • Poquet F.
      • Gencel L.
      • Clementy J.
      • Marcus F.I.
      Radiofrequency catheter ablation of common atrial flutter in 200 patients.
      ,
      • Lesh M.D.
      • Van Hare G.F.
      • Epstein L.M.
      • Fitzpatrick A.P.
      • Scheinman M.M.
      • Lee R.J.
      • Kwasman M.A.
      • Grogin H.R.
      • Griffin J.C.
      Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanisms.
      ,
      • Lee M.A.
      • Morady F.
      • Kadish A.
      • Schamp D.J.
      • Chin M.C.
      • Scheinman M.M.
      • Griffin J.C.
      • Lesh M.D.
      • Pederson D.
      • Goldberger J.
      • et al.
      Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia.
      The identified arrhythmogenic substrate can be targeted and ablated using radiofrequency current with a generally high success rate.
      • Jackman W.M.
      • Wang X.Z.
      • Friday K.J.
      • Roman C.A.
      • Moulton K.P.
      • Beckman K.J.
      • McClelland J.H.
      • Twidale N.
      • Hazlitt H.A.
      • Prior M.I.
      • et al.
      Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current.
      ,
      • Kay G.N.
      • Epstein A.E.
      • Dailey S.M.
      • Plumb V.J.
      Role of radiofrequency ablation in the management of supraventricular arrhythmias experience in 760 consecutive patients.
      Patients in whom the clinical arrhythmia is atypical, unstable, not readily reproducible, or poorly tolerated often require extensive and multicatheter electrophysiologic evaluation including various pacing maneuvers to confirm the tachycardia mechanism and origin.
      • Chen S.A.
      • Chiang C.E.
      • Yang C.J.
      • Cheng C.C.
      • Wu T.J.
      • Wang S.P.
      • Chiang B.N.
      • Chang M.S.
      Radiofrequency catheter ablation of sustained intra-atrial reentrant tachycardia in adult patients. Identification of electrophysiological characteristics and endocardial mapping techniques.
      ,
      • Kadish A.H.
      • Morady F.
      The response of paroxysmal supraventricular tachycardia to overdrive atrial and ventricular pacing can it help determine the tachycardia mechanism?.
      Ablation procedures in these patients are time consuming and sometimes unsuccessful and may be related in part to conventional catheter techniques allowing only recordings from a limited amount of sites simultaneously. Therefore, to overcome the limitations in mapping methods, new mapping techniques and catheters have recently been introduced.
      • Schmitt C.
      • Zrenner B.
      • Schneider M.
      • Karch M.
      • Ndrepepa G.
      • Deisenhofer I.
      • Weyerbrock S.
      • Schreieck J.
      • Schomig A.
      Clinical experience with a novel multielectrode basket catheter in right atrial tachycardias.
      ,
      • Schilling R.J.
      • Peters N.S.
      • Davies D.W.
      Feasibility of a noncontact catheter for endocardial mapping of human ventricular tachycardia.
      ,
      • Gepstein L.
      • Hayam G.
      • Ben-Haim S.A.
      A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart. In vitro and in vivo accuracy results.
      One of these is a high-resolution non-contact mapping system designed to create endocardial activation maps of the surrounding chamber by recording from >3,300 sites simultaneously and to guide ablation catheters to potential ablation sites. Clinical experience of this new technology in humans is still very limited.
      • Schilling R.J.
      • Peters N.S.
      • Davies D.W.
      Feasibility of a noncontact catheter for endocardial mapping of human ventricular tachycardia.
      ,
      • Schilling R.J.
      • Peters N.S.
      • Davies D.W.
      Simultaneous endocardial mapping in the human left ventricle using a noncontact catheter comparison of contact and reconstructed electrograms during sinus rhythm.
      ,
      • Schilling R.J.
      • Davies D.W.
      • Peters N.S.
      Characteristics of sinus rhythm electrograms at sites of ablation of ventricular tachycardia relative to all other sites a noncontact mapping study of the entire left ventricle.
      Therefore, we investigated the clinical performance, safety, and efficacy of the system as a diagnostic and therapeutic tool in patients with focal right atrial tachycardias. It was the purpose of the study to rapidly determine the tachycardia origin and to ablate the arrhythmia using the nonfluoroscopic-guiding capabilities of the non-contact mapping system.
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      References

        • Jackman W.M.
        • Wang X.Z.
        • Friday K.J.
        • Roman C.A.
        • Moulton K.P.
        • Beckman K.J.
        • McClelland J.H.
        • Twidale N.
        • Hazlitt H.A.
        • Prior M.I.
        • et al.
        Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current.
        N Engl J Med. 1991; 324: 1605-1611
        • Feld G.K.
        • Fleck R.P.
        • Chen P.-S.
        • Boyce K.
        • Bahnson T.D.
        • Stein J.B.
        • Calisi C.M.
        • Ibarra M.
        Radiofrequency catheter ablation for the treatment of human type 1 atrial flutter. Identification of a critical zone in the reentrant circuit by endocardial mapping techniques.
        Circulation. 1992; 86: 1233-1240
        • Kay G.N.
        • Chong F.
        • Epstein A.E.
        • Dailey S.M.
        • Plumb V.J.
        Radiofrequency ablation for treatment of primary atrial tachycardias.
        J Am Coll Cardiol. 1993; 21: 901-909
        • Fischer B.
        • Jais P.
        • Shah D.
        • Chouairi S.
        • Haissaguerre M.
        • Garrigues S.
        • Poquet F.
        • Gencel L.
        • Clementy J.
        • Marcus F.I.
        Radiofrequency catheter ablation of common atrial flutter in 200 patients.
        J Cardiovasc Electrophysiol. 1996; 7: 1225-1233
        • Lesh M.D.
        • Van Hare G.F.
        • Epstein L.M.
        • Fitzpatrick A.P.
        • Scheinman M.M.
        • Lee R.J.
        • Kwasman M.A.
        • Grogin H.R.
        • Griffin J.C.
        Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanisms.
        Circulation. 1994; 89: 1074-1089
        • Lee M.A.
        • Morady F.
        • Kadish A.
        • Schamp D.J.
        • Chin M.C.
        • Scheinman M.M.
        • Griffin J.C.
        • Lesh M.D.
        • Pederson D.
        • Goldberger J.
        • et al.
        Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia.
        Circulation. 1991; 83: 827-835
        • Kay G.N.
        • Epstein A.E.
        • Dailey S.M.
        • Plumb V.J.
        Role of radiofrequency ablation in the management of supraventricular arrhythmias.
        J Cardiovasc Electrophysiol. 1993; 4: 371-389
        • Chen S.A.
        • Chiang C.E.
        • Yang C.J.
        • Cheng C.C.
        • Wu T.J.
        • Wang S.P.
        • Chiang B.N.
        • Chang M.S.
        Radiofrequency catheter ablation of sustained intra-atrial reentrant tachycardia in adult patients. Identification of electrophysiological characteristics and endocardial mapping techniques.
        Circulation. 1993; 88: 578-587
        • Kadish A.H.
        • Morady F.
        The response of paroxysmal supraventricular tachycardia to overdrive atrial and ventricular pacing.
        J Cardiovasc Electrophysiol. 1993; 4: 239-252
        • Schmitt C.
        • Zrenner B.
        • Schneider M.
        • Karch M.
        • Ndrepepa G.
        • Deisenhofer I.
        • Weyerbrock S.
        • Schreieck J.
        • Schomig A.
        Clinical experience with a novel multielectrode basket catheter in right atrial tachycardias.
        Circulation. 1999; 99: 2414-2422
        • Schilling R.J.
        • Peters N.S.
        • Davies D.W.
        Feasibility of a noncontact catheter for endocardial mapping of human ventricular tachycardia.
        Circulation. 1999; 99: 2543-2552
        • Gepstein L.
        • Hayam G.
        • Ben-Haim S.A.
        A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart. In vitro and in vivo accuracy results.
        Circulation. 1997; 95: 1611-1622
        • Schilling R.J.
        • Peters N.S.
        • Davies D.W.
        Simultaneous endocardial mapping in the human left ventricle using a noncontact catheter.
        Circulation. 1998; 98: 887-898
        • Schilling R.J.
        • Davies D.W.
        • Peters N.S.
        Characteristics of sinus rhythm electrograms at sites of ablation of ventricular tachycardia relative to all other sites.
        J Cardiovasc Electrophysiol. 1998; 9: 921-933
        • Tracy C.M.
        • Swartz J.F.
        • Fletcher R.D.
        • Hoops H.G.
        • Solomon A.J.
        • Karasik P.E.
        • Mukherjee D.
        Radiofrequency catheter ablation of ectopic atrial tachycardia using paced activation sequence mapping.
        J Am Coll Cardiol. 1993; 21: 910-917