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Recent advances in three-dimensional electroanatomical mapping guidance for the ablation of complex atrial and ventricular arrhythmias

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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-re-entrant 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.

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Acknowledgements

The authors acknowledge Matteo Mirarchi, BE, for technical support in image editing.

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Authors and Affiliations

  1. Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I – Lancisi - Salesi”, Ancona, Italy

    Paolo Compagnucci, Giovanni Volpato, Umberto Falanga, Laura Cipolletta, Manuel Conti, Gino Grifoni, Letizia Verticelli, Michela Casella, Federico Guerra & Antonio Dello Russo

  2. Radiology Department, University Hospital “Ospedali Riuniti Umberto I – Lancisi - Salesi”, Ancona, Italy

    Nicolò Schicchi & Andrea Giovagnoni

  3. Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy

    Andrea Giovagnoni & Michela Casella

  4. Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy

    Federico Guerra & Antonio Dello Russo

Authors
  1. Paolo Compagnucci
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  2. Giovanni Volpato
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  3. Umberto Falanga
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  4. Laura Cipolletta
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  5. Manuel Conti
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  6. Gino Grifoni
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  7. Letizia Verticelli
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  8. Nicolò Schicchi
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  9. Andrea Giovagnoni
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  10. Michela Casella
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  11. Federico Guerra
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  12. Antonio Dello Russo
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Corresponding author

Correspondence to Paolo Compagnucci.

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ESM 1

Propagation map of atrial macro-re-entrant tachycardia obtained with the coherent mapping module. Note the critical isthmus in the region between the inferior cava vein and the scar due to prior atriotomy and, also, a second bystander isthmus in the superior portion of the posterior wall, close to the superior cava vein. The representation of small moving vectors simplifies interpretation of arrhythmia’s circuitry. (MP4 44,322 kb)

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Compagnucci, P., Volpato, G., Falanga, U. et al. Recent advances in three-dimensional electroanatomical mapping guidance for the ablation of complex atrial and ventricular arrhythmias. J Interv Card Electrophysiol 61, 37–43 (2021). https://doi.org/10.1007/s10840-020-00781-3

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  • DOI: https://doi.org/10.1007/s10840-020-00781-3

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