New method for nonfluoroscopic endocardial mapping in humans: Accuracy assessment and first clinical results

• Published in: Circulation (New York, N.Y.) Vol. 97; no. 24; pp. 2426 - 2432
• Main Authors: SMEETS, J. L. R. M, BEN-HAIM, S. A, RODRIGUEZ, L.-M, TIMMERMANS, C, WELLENS, H. J. J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 23-06-1998; American Heart Association, Inc
• Subjects: Adolescent; Adult; Aged; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - surgery; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Catheter Ablation - instrumentation; Catheter Ablation - methods; Electrodes; Electrophysiology; Endocardium; Female; Heart; Heart - anatomy & histology; Heart - physiology; Humans; Image Processing, Computer-Assisted; Magnetics; Male; Medical sciences; Middle Aged; Human; Preexcitation ventricular syndrome; Arrhythmia; Electrophysiology; Endocardium; Cardiovascular disease; Exploration; Ventricular tachycardia; Wolff Parkinson White syndrome; Conduction disorder; Excitability disorder; Heart mapping; Heart disease; Paroxysmal atrial tachycardia; Technique
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.97.24.2426

Accurate mapping of the site of origin and activation sequence of a cardiac arrhythmia is essential for a successful catheter ablation procedure. To achieve this, precise and reproducible catheter manipulation is mandatory. The aim of this study was (1) to assess the accuracy of a new nonfluoroscopic mapping system in humans and (2) to report the first result of endocardial activation mapping with this system during sinus rhythm and several types of supraventricular and ventricular tachycardias.
Fifteen patients were studied. Accuracy measurements were performed in 5 of them (patients 5, 6, 7, 8, and 14). The distances between two subsequent catheter positions in the inferior caval vein as determined by the nonfluoroscopic mapping system were compared with measurements made with calipers by four independent investigators using identification marks on the catheter shaft. The difference between these two methods was 0.95+/-0.8 mm. In 15 patients, activation of the right atrium and/or the right or left ventricle was recorded during sinus rhythm. Three-dimensional activation maps were constructed in patients with atrial and ventricular tachycardias and Wolff-Parkinson-White syndrome.
With this new nonfluoroscopic mapping technique, accurate positioning of the catheter tip is possible. A three-dimensional activation map can be reconstructed during sinus rhythm and during supraventricular and ventricular tachycardias of different compartments of the heart.