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A novel intra-operative, high-resolution atrial mapping approach.

Yaksh A, van der Does LJ, Kik C, Knops P, Oei FB, van de Woestijne PC, Bekkers JA, Bogers AJ, Allessie MA, de Groot NM - J Interv Card Electrophysiol (2015)

Bottom Line: This technique was performed in 168 patients of 18 years and older, with coronary and/or structural heart disease, with or without AF, electively scheduled for cardiac surgery and a ventricular ejection fraction above 40 %.The mean duration of the entire mapping procedure including preparation time was 9 ± 2 min.Complications related to the mapping procedure during or after cardiac surgery were not observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Erasmus Medical Center, PO Box 2040, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands.

ABSTRACT

Purpose: A new technique is demonstrated for extensive high-resolution intra-operative atrial mapping that will facilitate the localization of atrial fibrillation (AF) sources and identification of the substrate perpetuating AF.

Methods: Prior to the start of extra-corporal circulation, a 8 × 24-electrode array (2-mm inter-electrode distance) is placed subsequently on all the right and left epicardial atrial sites, including Bachmann's bundle, for recording of unipolar electrograms during sinus rhythm and (induced) AF. AF is induced by high-frequency pacing at the right atrial free wall. A pacemaker wire stitched to the right atrium serves as a reference signal. The indifferent pole is connected to a steal wire fixed to subcutaneous tissue. Electrograms are recorded by a computerized mapping system and, after amplification (gain 1000), filtering (bandwidth 0.5-400 Hz), sampling (1 kHz) and analogue to digital conversion (16 bits), automatically stored on hard disk. During the mapping procedure, real-time visualization secures electrogram quality. Analysis will be performed offline.

Results: This technique was performed in 168 patients of 18 years and older, with coronary and/or structural heart disease, with or without AF, electively scheduled for cardiac surgery and a ventricular ejection fraction above 40 %. The mean duration of the entire mapping procedure including preparation time was 9 ± 2 min. Complications related to the mapping procedure during or after cardiac surgery were not observed.

Conclusions: We introduce the first epicardial atrial mapping approach with a high resolution of ≥1728 recording sites which can be performed in a procedure time of only 9±2 mins. This mapping technique can potentially identify areas responsible for initiation and persistence of AF and hopefully can individualize both diagnosis and therapy of AF.

No MeSH data available.


Related in: MedlinePlus

A pacemaker wire stitched to the right atrial free wall serving as a temporal reference electrode (top). A steal wire fixed to (sub)cutaneous tissue serving as the indifferent electrode (bottom). RA right atrium, RV right ventricle
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Fig1: A pacemaker wire stitched to the right atrial free wall serving as a temporal reference electrode (top). A steal wire fixed to (sub)cutaneous tissue serving as the indifferent electrode (bottom). RA right atrium, RV right ventricle

Mentions: Prior to commencement to extra-corporal circulation, after heparinization and arterial cannulation, a temporary bipolar epicardial pacemaker wire is stitched to the right atrial free wall serving as a temporal reference electrode. The indifferent electrode consists of a steal wire fixed to subcutaneous tissue of the thoracic cavity (Fig. 1). Epicardial mapping during sinus rhythm and (induced) AF is performed with a custom-made flexible 192-unipolar electrode mapping array, mounted on a custom-made spatula if preferred by the surgeon. The spatula can be bended to match the atrial curvature (Fig. 2). If AF is not the presenting rhythm, AF is induced by fixed rate pacing at the right atrial free wall using a different temporary bipolar pacing wire. Recordings of real-time epicardial electrograms from Bachmann’s bundle are used to confirm atrial capture. Fixed rate pacing is started at a rate of 200 beats per minute (bpm). If an AF induction attempt is not successful after three burst attempts, the rate is increased by 50 bpm, up to maximal 400 bpm until AF occurs or atrial refractoriness is reached. After completion of the mapping procedure, AF is terminated by electrical cardioversion or sustained until cardioplegia is conducted, depending on the operators’ preference. In case of AF as the initial heart rhythm, electrical cardioversion is performed in order to map sinus rhythm after completing mapping of AF.Fig. 1


A novel intra-operative, high-resolution atrial mapping approach.

Yaksh A, van der Does LJ, Kik C, Knops P, Oei FB, van de Woestijne PC, Bekkers JA, Bogers AJ, Allessie MA, de Groot NM - J Interv Card Electrophysiol (2015)

A pacemaker wire stitched to the right atrial free wall serving as a temporal reference electrode (top). A steal wire fixed to (sub)cutaneous tissue serving as the indifferent electrode (bottom). RA right atrium, RV right ventricle
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4641159&req=5

Fig1: A pacemaker wire stitched to the right atrial free wall serving as a temporal reference electrode (top). A steal wire fixed to (sub)cutaneous tissue serving as the indifferent electrode (bottom). RA right atrium, RV right ventricle
Mentions: Prior to commencement to extra-corporal circulation, after heparinization and arterial cannulation, a temporary bipolar epicardial pacemaker wire is stitched to the right atrial free wall serving as a temporal reference electrode. The indifferent electrode consists of a steal wire fixed to subcutaneous tissue of the thoracic cavity (Fig. 1). Epicardial mapping during sinus rhythm and (induced) AF is performed with a custom-made flexible 192-unipolar electrode mapping array, mounted on a custom-made spatula if preferred by the surgeon. The spatula can be bended to match the atrial curvature (Fig. 2). If AF is not the presenting rhythm, AF is induced by fixed rate pacing at the right atrial free wall using a different temporary bipolar pacing wire. Recordings of real-time epicardial electrograms from Bachmann’s bundle are used to confirm atrial capture. Fixed rate pacing is started at a rate of 200 beats per minute (bpm). If an AF induction attempt is not successful after three burst attempts, the rate is increased by 50 bpm, up to maximal 400 bpm until AF occurs or atrial refractoriness is reached. After completion of the mapping procedure, AF is terminated by electrical cardioversion or sustained until cardioplegia is conducted, depending on the operators’ preference. In case of AF as the initial heart rhythm, electrical cardioversion is performed in order to map sinus rhythm after completing mapping of AF.Fig. 1

Bottom Line: This technique was performed in 168 patients of 18 years and older, with coronary and/or structural heart disease, with or without AF, electively scheduled for cardiac surgery and a ventricular ejection fraction above 40 %.The mean duration of the entire mapping procedure including preparation time was 9 ± 2 min.Complications related to the mapping procedure during or after cardiac surgery were not observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Erasmus Medical Center, PO Box 2040, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands.

ABSTRACT

Purpose: A new technique is demonstrated for extensive high-resolution intra-operative atrial mapping that will facilitate the localization of atrial fibrillation (AF) sources and identification of the substrate perpetuating AF.

Methods: Prior to the start of extra-corporal circulation, a 8 × 24-electrode array (2-mm inter-electrode distance) is placed subsequently on all the right and left epicardial atrial sites, including Bachmann's bundle, for recording of unipolar electrograms during sinus rhythm and (induced) AF. AF is induced by high-frequency pacing at the right atrial free wall. A pacemaker wire stitched to the right atrium serves as a reference signal. The indifferent pole is connected to a steal wire fixed to subcutaneous tissue. Electrograms are recorded by a computerized mapping system and, after amplification (gain 1000), filtering (bandwidth 0.5-400 Hz), sampling (1 kHz) and analogue to digital conversion (16 bits), automatically stored on hard disk. During the mapping procedure, real-time visualization secures electrogram quality. Analysis will be performed offline.

Results: This technique was performed in 168 patients of 18 years and older, with coronary and/or structural heart disease, with or without AF, electively scheduled for cardiac surgery and a ventricular ejection fraction above 40 %. The mean duration of the entire mapping procedure including preparation time was 9 ± 2 min. Complications related to the mapping procedure during or after cardiac surgery were not observed.

Conclusions: We introduce the first epicardial atrial mapping approach with a high resolution of ≥1728 recording sites which can be performed in a procedure time of only 9±2 mins. This mapping technique can potentially identify areas responsible for initiation and persistence of AF and hopefully can individualize both diagnosis and therapy of AF.

No MeSH data available.


Related in: MedlinePlus