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32. Cardiovascular Nursing
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High-density 3D voltage mapping with a single-puncture approach for catheter ablation of atrial fibrillation
Session:
Posters 5 - Écran 06 - Arritmologia Invasiva
Speaker:
Mário Martins Oliveira
Congress:
CPC 2018
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters
FP Number:
---
Authors:
Mário Martins Oliveira; Pedro Silva Cunha; Bruno Tereno Valente; Manuel Nogueira Da Silva; Guilherme Portugal; Madalena Coutinho Cruz; Rita Ilhao; Ana Sofia Delgado; Nuno Monteiro; Rui Cruz Ferreira
Abstract
<p>High-density mapping is an innovative tool with a potential impact in the ablation of complex arrhythmias. We assessed the feasibility, safety and efficacy of high-resolution mapping using a 20-pole flexible catheter to guide atrial fibrillation (AF) ablation. Methods: 26 patients (P) were prospectively included and followed a specified protocol: segmentation of the cardiac CT scan, venous access insertion, placement of a 10-pole catheter in the coronary sinus (CS), His location, single transseptal puncture using a defectable sheath, followed by left atrium (LA) and pulmonary veins (PV) high-density voltage mapping. P with AF when admitted to the lab underwent external electrical cardioversion. Mapping was done with a 20-pole catheter during sinus rhythm (SR) or during distal CS pacing with the following settings: filtering cycle length: 550-650ms, LAT stability: 5ms, position stability: 5mm, density: 1mm, voltage scale: <0,2 mV. After mapping, the 20-pole catheter was changed by the ablation catheter to perform pulmonary veins (PV) isolation with a wide area circumferential ablation (confirmed by bi-directional block). Remapping was performed to analyze signals, possible gaps and low-voltage areas. If so, ablation of gaps followed by remap to confirm homogeneous low-voltage and PV isolation was done. Results: From the P included (54% males, 56.7±9.7 yrs), 65% presented paroxysmal AF and 35% had history of persistent AF. Mean procedure duration was 160±38min, X-ray time was 21±10 min and RF time was 30±16 min. The average number of mapping points and acquisition times were: MAP 1 - 530 points (200-2200), 18±9 min; MAP 2 (all P) - 518 points (215-2620), 11±5 min; and MAP 3 (8P) - 223 points (130-1900), 7±4 min. There were no procedure complications. All P were in SR after ablation. During a mean follow-up of 18 months (range 12-27), 6P (23%) showed AF recurrence, documented by EKG/external event recorder. Conclusion: High-density multi-electrode mapping using a single-puncture approach is a safe and accurate technique for AF ablation with promising results.</p>
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