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Objective: To explore the safety and efficacy of two modeling methods of CARTO3 system for radiofrequency catheter ablation (RFCA) in paroxysmal atrial fibrillation (PAF) patients. Methods: A total of 150 PAF patients with RFCA were randomly divided into 3 groups: Group A: using conventional point-to-point mapping to guide circumferential pulmonary vein isolation; Group B, using fast anatomical modeling to guide circumferential pulmonary vein RFCA; Group C, using combined application of 2 mapping methods to guide circumferential pulmonary vein RFCA. n=50 in each group and the rest operative procedures were the same in 3 groups. The operative time, X-ray exposure time, success rate and complication rates were recorded in 3 groups; the size of left atrium and systolic function of left ventricle at pre- and 6 months post-operation were compared. Results: Compared with Group A and Group B, Group C had the shorter operative time and X-ray exposure time, P<0.05;the success rates were similar among 3 groups. No serious complication occurred in all 3 groups. Echocardiography presented that compared with pre-operative condition, the size of left atrium and LVEF were similar at 6 months post-operation. Conclusion: Combined using of two modeling methods of CARTO3 system was safe and effective for RFCA in PAF patients; it may reduce the operative time and X-ray exposure time, improve the accuracy of circumferential pulmonary vein locating and help guiding RFCA of PAF at certain degree.
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Objective: To investigate the safety and efficacy of CARTO3 fast anatomical mapping during radiofrequency ablation in patients with paroxysmal atrial ifbrillation (PAF). Methods: A total of 120 PAF patients treated in our hospital from 2013-01 to 2015-07 were enrolled. All patients received CARTO3 system for mapping and they were randomly divided into 2 groups: Control group, the patients had selective pulmonary vein angiography, followed by conventional point by point method to reconstruct left atrial model for guiding the ablation of PFA and Treatment group, the patients had selective pulmonary vein angiography followed by fast anatomical mapping to build left atrial model for guiding the ablation of PFA; the rest operational steps such as trans-septal and circumferential pulmonary vein ablation were the same.n=60 in each group. The times of operation, X-ray exposure and the rates of success, complication occurrence were compared between 2 groups. Results: All patients were successfully completed radiofrequency ablation for PAF. Compared with Control group, Treatment group had increased modeling time (8.5 ± 3.6) min vs (5.2 ± 2.3) min, while decreased pulmonary vein ostium determing time (12.0 ± 5.6) min vs (25.0 ± 8.4) min, circumferential pulmonary vein ablation time (95.0 ± 22.0) min vs (115.0 ± 25.0) min and X-ray exposure time (15.0 ± 6.3) min vs (24.0 ±5.5) min, allP0.05. Conclusion: CARTO3 fast anatomical mapping is safe and effective for guiding radiofrequency ablation in PAF patients, it may decrease the X-ray exposure time and operation time which were important for treating the relevant patients.
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Introduction: Radiofrequency ablation of scar related right atrial flutter is challenging. Long procedures, prolonged fluoroscopic times and high percentages of recurrences are of concern. We present a simple and progressive approach based on a single electroanatomic map of the right atrium. Methods: Twenty-two consecutive patients with atrial flutter and history of cardiac surgery were included. An electrophysiologic study was performed to define localization (left or right) and cavo-tricuspid isthmus participation using entrainment mapping. After a critical isthmus was localized, ablation was performed with an external irrigated tip catheter with a power limit of 30 W. Potential ablation sites were confirmed by entrainment. Results: The predominant cardiopathy was atrial septal defect. All arrhythmias were localized in the right atrium; mean cycle length of the clinical flutter was 274 ± 31 ms. Only 40% had cavo-tricuspid isthmus participation. None of the patients with successful ablation had recurrences after 13 ± 9.4 months of follow-up. Conclusions: A progressive approach with only one activation/voltage CARTO® map of the atrium and ablation of all potential circuits is a highly effective method for ablating scar related macroreentrant atrial arrhythmias.
Introducción: La ablación con radiofrecuencia de flutter auricular relacionado con cicatrices posquirúrgicas es compleja. Procedimientos prolongados, con tiempos de fluoroscopia altos y una tasa de recurrencia elevada son problemas habituales. Mostramos un abordaje simple y progresivo basado en un solo mapa de cartografía electroanatómica de la aurícula derecha. Métodos: Se incluyeron 22 pacientes consecutivos con flutter auricular e historia de cirugía cardiaca. Se realizó estudio electrofisiológico para definir la localización del circuito de flutter (derecho o izquierdo) y la participación o no del istmo cavotricuspideo mediante encarrilamiento. Una vez localizado la zona de conducción lenta o critica del circuito, se realizó ablación con radiofrecuencia con catéter de irrigación externa a 30W. Posteriormente se llevó a cabo ablación de todos los circuitos potenciales. Resultados: La cardiopatía más dominante fue la comunicación interauricular. Todas las arritmias se localizaron en la aurícula derecha. El ciclo de flutter fue de 274 ± 31 ms. En solo 40% de los casos se demostró participación del istmo cavotricuspideo. No se observaron recurrencias de la arritmia durante un seguimiento de 13 ± 9.4 meses. Conclusiones: Este abordaje escalonado con un solo mapa CARTO® de activación/voltaje de la aurícula y la ablación de todos los circuitos potenciales es altamente efectivo para el tratamiento de arritmias por macrorreentrada relacionadas con cicatriz posquirúrgica.
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Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Catheter Ablation/methods , Cicatrix/complications , Cicatrix/surgery , Tachycardia/etiology , Tachycardia/surgery , Heart AtriaABSTRACT
Objective: To summarize our initial experience on three-dimensional electroanatomic mapping with Carto-Merge, so as to provide evidence for guiding catheter ablation of atrial fibrillation (AF). Methods: Fifteen patients with paroxysmal/persistent AF (13 paroxysmal and 2 persistent), who were to receive catheter ablation, were analyzed by CARTO-MERGE, which combines computed tomography (CT) angiography, picture merging, guiding ablation, etc. Results: There were 103±13 mapping points before ablation, with 66±15 in the left ablation circle and 58±20 in the right. The distance between points and surface was (1.8 ± 0.2) mm in the merged images. Operation time was (305 ± 45) min and the X-ray exposure time was (52 ± 18) min. Isolation of pulmonary veins potential was achieved in all patients and there was no complication during the operation. Conclusion: Three-dimensional CT images is very close to the the real anatomy of left atrium and pulmonary veins. Carto-merge technique can overcome some shortcomings of Carto electroanatomic mapping pictures, which can improve the successful rate of operation and reduce complication.
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Objective:To investigate the efficacy and safety of catheter radiofrequency ablation for focal atrial tachycardia,by comparing conventional mapping group and Carto system mapping group.Methods:50 patients with focal atrial tachycardia underwent electrophysiologic study and radiofrequency ablation.32 cases were in conventional mapping group,and 25 cases in Carto system mapping group,including 7 cases with unsuccessful ablation in conventional mapping group.During follow-up 20?11 months,radiofrequency ablation acute successful rate,long-term successful rate,safety,and the clinical symptoms were recorded.ⅹ-ray radiation exposure time was compared between conventional mapping group and Carto system mapping group.Results: ① radiofrequency ablation acute successful rate of conventional mapping group and Carto system mapping group were 78% and 100%,and long-term successful rate were 68% and 96% respectively.No complications occurred.The clinical symptoms caused by focal atrial tachycardia disappeared after successful ablation.② ⅹ-ray radiation exposure time of Carto system mapping group was shorter than that of conventional mapping group.Conclusions: Successful rate and safety of radiofrequency ablation of focal atrial tachycardia were higher,and effects of Carto system mapping group were better than those of conventional mapping group.And X-ray radiation exposure time of Carto system mapping group decreased.
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Objective To characterize the electroanatomical mapping and to assess the value of radiofrequency ablation of atrial tachycardia (AT) in left atria. Methods Nine patients with AT in left atria were studied. Three-dimensional electroanatomical maps were constructed in left atrium using electroanatomical mapping system (Carto). The type of AT (focal or macroreentrant) was identified by the electroanatomical maps, and the ablation targets were at the earliest activation sites or the isthmus of circuit. Results There were ten ATs in 9 cases. The relatively early A waves were recorded in middle, distal or proximal parts of coronary sinus catheter. Nine focal ATs were diagnosed. The activation maps demonstrated that the earliest activation sites were at the ostium of pulmonary veins ( n =5), posterior area of left atrium ( n =2), ostia of left atria appendage ( n =1) or left atria appendage ( n =1) respectively. One macroreeentrant AT was diagnosed, whose circuit propagated through the isthmus, formed by the right superior pulmonary vein and fossa ovalis. Eight focal ATs were all ablated successfully at the earliest activation sites, and one AT from left atria appendage was ablated unsuccessfully. Line of ablation was performed at the isthmus of the macroreentrant AT. During a period of 6-30 months follow-up, one patient with focal AT recurred and underwent another ablation with successful result. No complication occurred. The procedure time and the fluoroscopic time were 90-140 min, 8-16 min respectively in successful cases. Conclusion These results suggest that electroanatomical mapping of AT in left atria may facilitate rapid and accurate identification of the type of AT and guide ablation safely or effectively with less fluoroscopic time and higher success rate, especially in unsuccessful cases with conventional technique.
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Objective To evaluate clinically electroanatomical mapping and ablation of cardiac arrhythmias under the Carto system. Methods Fifty-six patients with various tachycardias indicated for electrophysiological study and radiofrequency ablation were included in this study, among of whom, 49 suffered from supraventricular tachycardia, and 7 ventricular tachycardia (VT). Carto system was utilized during ongoing tachycardia or sinus rhythm, 7F Navi-Star catheter was introduced into the interested cardiac chamber and underwent three-dimensional electroanatomical mapping. The mechanism and origin of cardiac arrhythmia were assessed by activation and propagation map, with which to guide radiofrequency ablation. Results The success ablation rate was 94.6% (53/56). One right accessory pathway (AP), one atrial tachycardia (AT) and one atypical atrial flutter (AF) had failed session. The procedure time was 128?59 minutes, and the fluoroscopic time 14?12 minutes. One patient had complcation of pneumothorax. No conduction block occurred. After follow-up of 1-14 months, one left AT recurred and had another succssful session. Conclusion The study demonstrates that Carto system is a safe and effective tool and may be applied for mapping and ablation of various tachyarrhythmias. It is helpful to guide catheter ablation and shorten fluorocopic time by its ability of associate intracardiac electrograms with their three-dimensional anatomic structure. It also lessen complication and recurrence by tagging the critical cardiac structures and utilize its location memory function. Our experience suggest that carto system has important role in the guidance of mapping and ablation in AT、AF、VT and complex or recurrent AP cases.
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Objective:To investigate the efficacy and safety of catheter radiofrequency ablation for ventricular tachycardia.Methods:Thirty-three patients with ventricular tachycardia were performed electrophysiologic study and radiofrequency ablation.Thirty cases with idiopathic ventricular tachycardia underwent pacemapping and/or activation mapping,and 3cases with arrhyththmogenic right ventricular cardiomyopathy underwent Carto system mapping.During the average follow-up of 28?17 months,acute successful rate and long-term successful rate of radiofrequency ablation were recorded ,and safety was observed.Rsults:①For radiofrequency ablation,the acute successful rate was 90.9%(30/33),and 3 cases without successful ablation were with idiopathic ventricular tachycardia;long-time successful rate was 87.9%(29/33),and 1 case with arrhyththmogenic right ventricular cardiomyopathy reoccurred.②Ventricular responses were induced by radiofrequency ablation in all successful cases.③No complication occurred.Conclusions:Successful rate and safety of radiofrequency ablation for ventricular tachycardia were high;and the ventricular responses during ablation could be the predictors for successful ablation.
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0.05), while when the CARTO technology was used, the mean fluoroscopy time was significantly shorter (6.3?2.6min vs 16.2?7.0min,P
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Objective To assess the clinical efficacy of electroanatomically guided mapping and radiofrequency ablation under CARTO system for premature ventricular contraction. Methods The CARTO electroanatomical mapping system displays real time three dimensional chamber structure with electrical information related to signal amplitude and activation time. Drugrefractory and frequent premature ventricular contractions were ablated under CARTO system. Results Frequent premature ventricular contractions were successfully ablated in all 8 patients with mean 2.2?1.7 radiofrequency applications under CARTO system. 6/8 frequent premature ventricular contractions occured in right ventricule, and 2/8 in left ventricule. After ablation, the premature ventricular contractions declined from 24 711?5 612 beats/24h to 0-5 beats/24h, and patient′s symptoms almost disappeared. No recurrent case was found during a period of 3-12 months following observation, and the premature ventricular contractions remained ≤10 beats/24h. Conclusions The CARTO electroanatomical mapping system, referred to the electrophysiologic data, may be applied in guiding the radiofrequency ablation of drug-refractory and frequent premature ventricular contractions in those patients who have no organic heart disease for its safety and accurate orientation.