Advanced mapping strategies for ablation therapy in adults with congenital heart disease
Fares-Alexander Alken1,2, Niklas Klatt1, Paula Muenkler1,2
1Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
Insights
Ultra-high density mapping (HDM) combined with automated algorithms offers detailed insights into complex arrhythmias in congenital heart disease (CHD) patients. This approach aids in tailoring catheter ablation strategies for improved patient outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Technology
Background:
- Complex arrhythmias are common complications in adults with congenital heart disease (CHD).
- Catheter ablation in CHD patients presents challenges due to anatomical variations and complex arrhythmogenic substrates.
- Ultra-high density mapping (HDM) is an emerging tool for managing these complex cases.
Purpose of the Study:
- To evaluate the initial experience of using HDM with automated annotation algorithms in adult CHD patients.
- To assess the feasibility and effectiveness of this combined approach in guiding catheter ablation for complex arrhythmias.
- To explore novel advanced mapping strategies for improved arrhythmia treatment in CHD.
Main Methods:
- Conducted HDM using the Rhythmia™ mapping system and a 64-electrode mini-basket catheter.
- Applied postprocedural signal processing with Lumipoint™ software for advanced analysis.
- Studied adult patients with moderate to great CHD complexity undergoing catheter ablation for symptomatic arrhythmias.
Main Results:
- 21 ablation procedures were performed in 19 patients with various arrhythmias, including atrial fibrillation, atrial tachycardia, and ventricular arrhythmias.
- Generated 56 high-density maps with an average of 12,043 mapping points.
- Automated annotation facilitated identification of critical isthmuses in 20 out of 27 activation maps, supporting ablation guidance.
Conclusions:
- HDM coupled with automated annotation algorithms provides comprehensive data on arrhythmia mechanisms in CHD.
- This integrated approach shows potential for facilitating personalized catheter ablation strategies in complex CHD patients.
- Further research can optimize these advanced mapping techniques for better clinical application.
Background:
Ultra-high density mapping (HDM) is a promising tool in the treatment of patients with complex arrhythmias. In adults with congenital heart disease (CHD), rhythm disorders are among the most common complications but catheter ablation can be challenging due to heterogenous anatomy and complex arrhythmogenic substrates. Here, we describe our initial experience using HDM in conjunction with novel automated annotation algorithms in patients with moderate to great CHD complexity.
Methods:
We studied a series of consecutive adult patients with moderate to great CHD complexity and an indication for catheter ablation due to symptomatic arrhythmia. HDM was conducted using the Rhythmia™ mapping system and a 64-electrode mini-basket catheter for identification of anatomy, voltage, activation pattern and critical areas of arrhythmia for ablation guidance. To investigate novel advanced mapping strategies, postprocedural signal processing using the Lumipoint™ software was applied.
Results:
In 19 patients (53±3 years; 53% male), 21 consecutive ablation procedures were conducted. Procedures included ablation of atrial fibrillation (n=7; 33%), atrial tachycardia (n=11; 52%), atrioventricular accessory pathway (n=1; 5%), the atrioventricular node (n=1; 5%) and ventricular arrhythmias (n=4; 19%). A total of 23 supraventricular and 8 ventricular arrhythmias were studied with the generation of 56 complete high density maps (atrial n=43; ventricular n=11, coronary sinus n=2) and an average of 12,043±1,679 mapping points. Multiple arrhythmias were observed in n=7 procedures (33% of procedures; range of arrhythmias detected 2-4). A total range of 1-4 critical areas were defined per procedure and treated within a radiofrequency application time of 16 (interquartile range 12-45) minutes. Postprocedural signal processing using Lumipoint™ allowed rapid annotation of fractionated signals within specific windows of interest. This supported identification of a practical critical isthmus in 20 out of 27 completed atrial and ventricular tachycardia activation maps.
Conclusions:
Our findings suggest that HDM in conjunction with novel automated annotation algorithms provides detailed insights into arrhythmia mechanisms and might facilitate tailored catheter ablation in patients with moderate to great CHD complexity.
