Journal of Interventional Cardiac Electrophysiology

, Volume 49, Issue 3, pp 319–326 | Cite as

A novel 3D anatomic mapping approach using multipoint high-density voltage gradient mapping to quickly localize and terminate typical atrial flutter

  • William C. Choe
  • Sri Sundaram
  • J. Ryan Jordan
  • Nate Mullins
  • Charles Boorman
  • Austin Davies
  • Alex C. Tiftickjian
  • Sunil Nath



The purposes of the study were to evaluate and characterize the cavotricuspid isthmus using multipoint high density voltage gradient mapping (HD-VGM) to see if this would improve on current ablation techniques compared to standard cavotricuspid isthmus ablation techniques.


Group 1, 25 patients who underwent ablation using standard methods of 3D mapping and ablation, was compared to group 2, 33 patients undergoing ablation using HD-VGM and ablation. Using this method, we are able to identify the maximum voltage areas within isthmus and target it for ablation. Total procedure times, ablation times and number of lesions, distance ablated, and fluoroscopy times were compared.


Fifty-eight patients were included in this study. Compared to group 1, in group 2, HD-VGM decreased the total ablation time 18.2 ± 9.2 vs 8.3 ± 4.0 min (p < 0.0001), total ablation lesions 22.7 ± 18.8 vs 5.5 ± 4.2 (p < 0.0001), and the length of the ablation lesions was significantly shorter 47.0 mm ± 13 mm vs 32.6 mm ± 10.0 mm (p < 0.0001). While the average length of the CTI was similar, 47.0 mm ± 13 mm vs 46.1 mm ± 10.0 mm (p 0.87), in group 2, only 71% of the isthmus was ablated.


Multipoint high density voltage gradient mapping can help identify maximum voltage areas within the isthmus and when ablated can create bidirectional block with decreased ablation times and length of the lesion.


Typical atrial flutter Radiofrequency ablation 3D anatomic mapping High density mapping Voltage gradient mapping Catheter ablation 



Atrial fibrillation


High density activation sequence mapping with voltage gradient mapping


Typical atrial flutter


Left atrium


Right atrium


Coronary sinus


Local activation timing


Roving activation interval

Low V ID

Low voltage identification





We thank Kimberly Oaks for helping edit the paper.

Compliance with ethical standards

Conflict of interest

Drs. Sundaram and Choe are on the speaker’s bureau and consultants for St. Jude Medical. In addition, Drs. Sundaram and Choe have received a research grant from St. Jude Medical, Asia Division to study the genetic basis of Brugada Syndrome in Cambodia. This conflict is not relevant to the article.

Dr. Jordan is a consultant for St Jude Medical.

N. Mullins, C. Boorman, and A Davies receive salary support from St. Jude Medical.

Dr. Sunil Nath and Alex C Tiftickjian have no conflict of interest to declare.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study, formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.South Denver Cardiology AssociatesLittletonUSA
  2. 2.St Jude MedicalSt PaulUSA
  3. 3.Porter Adventist HospitalDenverUSA
  4. 4.Colorado Springs CardiologistsColorado SpringsUSA

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