High-density electroanatomic mapping with grid catheter in pediatrics and congenital heart disease
Johannes C von Alvensleben1,2, Amneet Sandhu3, Shu Chang3
1Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Ave, B100, Aurora, CO, 80045, USA. Johannes.vonalvensleben@childrenscolorado.org.
Insights
The Advisor™ HD Grid mapping catheter is safe and effective for mapping arrhythmias in pediatric patients and those with congenital heart disease (CHD). This technology allows for high-density mapping with reduced procedure times in this unique population.
Area of Science:
- Cardiology
- Electrophysiology
- Pediatric Cardiology
Background:
- The Advisor™ HD Grid mapping catheter offers unique bipolar electrogram collection capabilities.
- Limited data exists on its use in pediatric patients and those with congenital heart disease (CHD).
Purpose of the Study:
- To evaluate the utility and safety of the Advisor™ HD Grid mapping catheter.
- To assess its application in pediatric and CHD populations.
Main Methods:
- Retrospective review of electrophysiologic studies using the Advisor™ HD Grid catheter.
- Inclusion criteria: pediatric patients and all ages with CHD.
Main Results:
- 65 procedures in 60 patients (31 female, median age 17 years) were analyzed.
- 30 procedures (46.1%) involved patients with CHD.
- Mapped 88 arrhythmia substrates, including atrial flutter, focal atrial tachycardia, PVCs, accessory pathways, AVNRT, and VT.
- Successful ablation in 92.4% of procedures.
- Patients with CHD required more maps and points per map.
Conclusions:
- The Advisor™ HD Grid mapping catheter is safe and effective for pediatric and CHD populations.
- It enables mapping of diverse arrhythmia substrates with high point density and efficiency.
Background:
The Advisor™ HD Grid mapping catheter (Abbott Laboratories; Chicago, IL) allows for bipolar electrogram collection in both orthogonal and perpendicular planes, unique when compared to traditional and branch catheters. Experience in pediatric patients and congenital heart disease (CHD) is limited. The purpose of this work was to evaluate the utility and safety of the Advisor™ HD Grid mapping catheter in pediatric and CHD populations.
Methods:
Retrospective review of all pediatric patients and those with CHD (regardless of age) at Children's Hospital Colorado and University of Colorado undergoing electrophysiologic study in which the Advisor™ HD Grid mapping catheter was utilized.
Results:
Sixty-five procedures in 60 patients (N = 31 female (47.6%), median age 17 years (15-24.1)) were included. Patients had CHD in 30 procedures (46.1%). Eight-eight arrhythmia substrates were mapped including atrial flutter/intra-atrial reentrant tachycardia (N = 33), focal atrial tachycardia (N = 20), isolated PVCs (N = 10), accessory pathways (N = 9), atrioventricular nodal reentrant tachycardia (N = 7), right ventricular substrate mapping (N = 7), and ventricular tachycardia (N = 2). Median time per map was 11.8 (7.5-20.1) min with 3.2 (± 1.7) maps per procedure and a median of 2634 (1767-7654) points used per map. Patients with CHD required more maps (p < 0.001) and points per map (p < 0.001). Ablation was successful in 92.4% of procedures.
Conclusions:
The Advisor™ HD Grid mapping catheter is safe and effective in the pediatric and congenital heart disease population. A wide variety of arrhythmia substrates can be mapped with high point density and low mapping time.
