![]() ![]() Patients who were in their clinical atrial arrhythmia at the start of the case had activation mapping simultaneous with geometry creation. Following access to the left atrium, a 3D geometry was created. Jude Livewire™, 2-10-2 mm electrode spacing catheter) was placed around the tricuspid valve annulus with the distal poles in the coronary sinus. Jude EnSite Velocity system with Precision Mapping Module. In this study, we report our experience with the use of ultra high density-activation sequence mapping (UHD-ASM) to determine the precise arrhythmia circuit and to identify potential targets for successful ablation.ģD geometry and mapping were done using the St. A combination of activation sequence mapping and entrainment has commonly been utilized to understand and ablate these arrhythmias. Mapping and ablation of these complex arrhythmias continue to be a challenge for clinical electrophysiologists. Many of these atrial flutters occur in patients who have undergone previous medical procedures such as valvular or congenital cardiac surgery involving atriotomy, surgical Maze operations, or pulmonary vein isolation procedures. Atypical atrial flutters, however, have proven more challenging to map and ablate. With the introduction of newer computer-driven mapping systems, it became clear that the vast majority of typical atrial flutters were reentrant and involved the right atrial caval-tricuspid isthmus in either a counterclockwise or clockwise rotational pattern. At 1 year of follow-up, 77% were free of atrial tachycardia or atrial flutter and 61% were free of all atrial arrhythmias.įor decades, there was a scientific debate as to whether or not typical atrial flutter was focal or reentrant. Thus, 28/31 (90.3%) terminated with RF energy and/or could not be reinduced after ASC ablation. Median time from initial ablation to AAF termination was 64 s. AAF degenerated to atrial fibrillation in 2/31 (6.5%) with RF and could not be reinduced after ASC ablation. We targeted the ASC and ablation terminated AAF directly in 19/31 (61.3%) and altered AAF activation in 7/31 (22.6%), all of which terminated directly with additional mapping/ablation. Macroreentry atrial flutters took varied pathways, but each had an area of slow conduction (ASC) averaging 16 ± 6 mm (range 6–29) in length. For every AAF, the entire circuit was identified. Time to create and interpret the UHD-ASM was 20 ± 11 min. ![]() For each AAF, 1273 ± 697 points were used for UHD-ASM.
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