3D Mapping for PVI- Geometry, Image Integration and Incorporation of Contact Force Into Work Flow.

Catheter ablation of atrial fibrillation has evolved enormously thanks to rapid improvement of modern mapping technologies, progress in catheter development and current possibilities for reduction of radiation exposure. Pulmonary vein isolation is thereby the cornerstone in this interventional treatment. Increased precision of catheter localization by modern three-dimensional mapping systems, faster and better processing of local electrograms and their immediate color-based visualization make it possible to treat even challenging arrhythmias very effectively. The commonly used three-dimensional mapping systems CARTO 3 (Biosense Webster, Irvine, Ca.) and Ensite Precision (St. Jude Medical, St. Paul, Min) differ in construction and principles of the underlying mapping technology. In this review article, we aim to emphasize the most important aspects of possibilities that make both systems so valuable for interventional treatment of atrial fibrillation. We present a modern workflow, that unites three-dimensional LA mapping with collecting relevant local information, image integration for refining the map and beneficial use of contact force based ablation approach.

Central versus thinnest pachymetry of the cornea and thinnest point vector length: impact of ocular side, refractive state, age, and sex.

PURPOSE: To quantify the difference in corneal thickness between the central and thinnest point (ΔCCT-TPCT) and the distance between the center of the cornea and its thinnest point (TPCT vector length) and to explore the impact of ocular side, refractive state, age, and sex. METHODS: Multicenter, retrospective, cross-sectional study. Medical records of 8054 eyes of 4027 refractive surgery candidates were reviewed. The correlation between ΔCCT-TPCT and TPCT vector length (Pentacam) and the variables refractive state, age, and sex were assessed. Spearman correlations, t tests, analysis of variance, analysis of covariance, and multiple regression models were used. RESULTS: ΔCCT-TPCT was higher in the left eyes of myopic (3.03 ± 2.29 µm) and hyperopic (4.97 ± 3.19 µm) subjects compared with myopic (2.39 ± 2.28 µm) and hyperopic (4.77 ± 3.97 µm; P < 0.05) right eyes. ΔCCT-TPCT was higher in hyperopic than in myopic (P < 0.001) eyes. TPCT vector length was 0.62 ± 0.28 mm for the right eye and 0.69 ± 0.24 mm for the left eye (P < 0.001). TPCT vector length tended to increase with advancing age. Age had the strongest independent effect on TPCT vector length in myopic (η = 0.018; P < 0.001) and hyperopic (η = 0.028; P = 0.006) right eyes. No difference was observed between male and female subjects. The correlations between ΔCCT-TPCT and TPCT vector length were strong (r > 0.8; P < 0.001). CONCLUSIONS: As a result of the significant differences found, normative data on ocular side, refractive state, and age should ideally be incorporated into ΔCCT-TPCT and TPCT vector length reference values.