- Email: [email protected]
P1-55
Poster 1 Methods: An 8F rotational ICE catheter (UltraICE™, Boston Scientific) was positioned outside the LIPV and perpendicular to the plane of the intended MI ablation line in 15 patients. Myocardial thickness and the relation to the esophagus were used to guide the location of the ablation line and to titrate power. Results: The esophagus (E) was visualized in close proximity to the superior MI near the LIPV in 7/15 patients. In 2 patients, the E remained in close apposition to MI along a large extent of a line straight to the mitral annulus (see CT and ICE images below), and also ⬍ 1mm from the coronary sinus (CS). In these 2 patients the E was largely avoided by creating a more antero-lateral ablation line. Myocardial thickness varied significantly throughout the MI and separation between the myocardium and E appeared minimal above the CS but more substantial between CS and mitral annulus (MA). Conclusions: In nearly half the patients in this study, the esophagus was in close proximity to the superior aspect of the mitral isthmus. ICE provides real-time information about regional myocardial thickness and relationship of the ablation site to the esophagus, which may be helpful during linear ablation. Caution must be used when ablating within the coronary sinus in the MI, as it may lie extremely close (⬍1mm) to the esophagus.
P1-54 CORRELATION BETWEEN CARTO ENDOCARDIAL MAPPING AND MRI WITH GADOLINIUM DELAYED ENHANCEMENT FOR THE DEFINITION OF MYOCARDIAL SCAR IN PATIENTS WITH VENTRICULAR TACHYCARDIA AND CHRONIC MYOCARDIAL INFARCTION A. Codreanu, MD, M. Andronache, MD, C. De Chillou, MD, PhD, Py Marie, MD, PhD and I. Magnin Poull. University of Nancy, Vandoeuvre, France. Background: Sinus Rhythm (SR) Radiofrequency Ablation is often the only possibility to cure the post infarction ventricular tachycardia (VT) due to intolerable or unstable circuits. The magnetic resonance imaging (MRI) data, in addition to the left ventricle (LV) Sinus Rhythm mapping can helps to precise the ablation strategy in order to obtain an optimal result. Aim of the Study: To correlate the electrograms (EGM) characteristics of the electroanatomic mapping of the left ventricle (LV) with the presence and transmural extent of the myocardial scar defined by MRI, in patients with VT and chronic myocardial infarction. Materials and Methods: Ten patients with VT and chronic myocardial infarction were studied by: (i) 3D endocardial mapping (CARTO) in sinus rhythm with analysis of unipolar and bipolar EGM amplitude, duration and fragmentation; (ii) cardiac MRI with scar definition according to 3D Gadolinium-DTPA delayed enhancement (DE), with analysis of location and transmural extent of the scar. Topographical relation between CARTO and MRI data was provided by an original LV segmentation ensuring ⬎1.5 mm spatial resolution and the correlation between EGM and DE characteristics were studied using logistic regression. Results: 1280 EGM were studied. Any of the EGM characteristics were highly correlated with the presence of DE (P⬍0.001), with threshold values: bipolar amplitude 1.66mV, bipolar duration 58 ms, unipolar amplitude 6.17mV. In multivariate analysis, bipolar duration and fragmentation provided supplemental diagnostic information (ROC 0.89; RR ⫽ 6.7 (95%CI 3.7-10.9)) over bipolar amplitude alone (ROC 0.84), for predicting the presence of myocardial scar. No reliable correlation with the transmural extent of the scar was found.
S125 Conclusion: EGM characteristics in CARTO mapping correctly predict the presence of myocardial infarction scar assessed by MRI, but poorly inform on its’ transmural extent. Combined use of bipolar amplitude, duration and fragmentation enhances the diagnostic accuracy for the presence of the scar.
P1-55 5 YEARS-FOLLOW UP AFTER SUCCESSFUL PULMONARY VEIN ISOLATION FOR ATRIAL FIBRILLATION Thomas Arentz, MD, Reinhold Weber, MD, Gerd Bu¨rkle, MD, Thomas Blum, MD, Jochem Stockinger, MD and Dietrich Kalusche, MD. Herzzentrum, Bad Krozingen, Germany. Transseptal pulmonary vein (PV)-Isolation is a new and promising treatment of atrial fibrillation (AF). The question remains if this treatment is a curative. Methods: 30 patients (51⫾12 years, 7 women, 6 with organic heart disease) with complete elimination of AF (paroxysmal n⫽25, persistent n⫽5) without antiarrhythmic drugs 1 year after ostial segmental PVIsolation were re-examined 5 years after the initial procedure. The follow up visit included a questionnaire regarding symptoms of AF, 24 hours holter monitoring and event monitoring if necessary. Results: 27 of the 30 had no symptoms of AF and no AF during 24 hours holter monitoring without antiarrhythmic drug treatment. Three of the 27 patients had a second ablation procedure ⬎1 year (14⫾3 months) after the initial procedure for recurrence of AF (2⫻ for recovery of PV conduction and in one patients linear ablation had been performed at the roof of the LA and between the left lower PV and the mitral annulus). Three patients had recurrence of AF: 1 patient had persistent AF, and 2 rare episodes of paroxysmal AF under antiarrhythmic drug treatment. Conclusions: 27 of 30 Patients (90%) seem to be cured from AF after successful ostial segmental PV-Isolation. Six patients had recurrence of AF more than 1 year after the initial procedure, 3 of them were reablated successfully. P1-56 MAGNETIC CATHETER NAVIGATION IS SAFE AND EFFECTIVE FOR ABLATION OF SUPRAVENTRICULAR TACHYCARIDA: RESULTS OF THE MULTI-CENTER ATTRAC STUDY Bruce D. Lindsay, MD, Gery F. Tomassoni, MD, Vivek Y. Reddy, MD, Ruchir Sehra, MD, Karen J. Beckman, MD, Stanislav Weiner, MD, Katherine Warner, BS and Jason Zagrodsky, MD. Washington University School of Medicine, St. Louis, MO, Central Baptist Hospital, Lexington, KY, Massachusetts General Hospital, Boston, MA, Stereotaxis, Inc, St. Louis, MO, Oklahoma University Medical Center, Oklahoma City, OK, Tyler Cardiovascular Consultants, Tyler, TX, Stereotaxis, Inc., St. Louis, MO and Texas Cardiac Arrhythmia Research, Austin, TX. Introduction: Preliminary single site studies have demonstrated the feasibility of using the Magnetic Navigation System (MNS), Stereotaxis, Inc., for mapping and ablation of supraventricular tachycardia (SVT). This report summarizes results of the ATTRAC (Arrhythmia Treatment with a Thermocouple Radiofrequency Ablation Catheter) study, which is the first large, prospective, multi-center study to assess the safety and efficacy of the MNS in patients with common SVT or atrial fibrillation with a rapid rate that was difficult to control. Methods: Adults who required ablation of accessory pathways, AV nodal reentry, or the AV node were eligible. The ablation procedures were performed at 7 clinical sites with either a 1- (Helios I) or 3-magnet, thermocouple, 4mm tip RF ablation catheter (Helios II) designed for the MNS. Helios II was used in 90% of patients. They were followed for 3 months post ablation to assess long-term success. Results: 182 patients met the inclusion criteria for the study. There were 69
P1-54 CORRELATION BETWEEN CARTO ENDOCARDIAL MAPPING AND MRI WITH GADOLINIUM DELAYED ENHANCEMENT FOR THE DEFINITION OF MYOCARDIAL SCAR IN PATIENTS WITH VENTRICULAR TACHYCARDIA AND CHRONIC MYOCARDIAL INFARCTION A. Codreanu, MD, M. Andronache, MD, C. De Chillou, MD, PhD, Py Marie, MD, PhD and I. Magnin Poull. University of Nancy, Vandoeuvre, France. Background: Sinus Rhythm (SR) Radiofrequency Ablation is often the only possibility to cure the post infarction ventricular tachycardia (VT) due to intolerable or unstable circuits. The magnetic resonance imaging (MRI) data, in addition to the left ventricle (LV) Sinus Rhythm mapping can helps to precise the ablation strategy in order to obtain an optimal result. Aim of the Study: To correlate the electrograms (EGM) characteristics of the electroanatomic mapping of the left ventricle (LV) with the presence and transmural extent of the myocardial scar defined by MRI, in patients with VT and chronic myocardial infarction. Materials and Methods: Ten patients with VT and chronic myocardial infarction were studied by: (i) 3D endocardial mapping (CARTO) in sinus rhythm with analysis of unipolar and bipolar EGM amplitude, duration and fragmentation; (ii) cardiac MRI with scar definition according to 3D Gadolinium-DTPA delayed enhancement (DE), with analysis of location and transmural extent of the scar. Topographical relation between CARTO and MRI data was provided by an original LV segmentation ensuring ⬎1.5 mm spatial resolution and the correlation between EGM and DE characteristics were studied using logistic regression. Results: 1280 EGM were studied. Any of the EGM characteristics were highly correlated with the presence of DE (P⬍0.001), with threshold values: bipolar amplitude 1.66mV, bipolar duration 58 ms, unipolar amplitude 6.17mV. In multivariate analysis, bipolar duration and fragmentation provided supplemental diagnostic information (ROC 0.89; RR ⫽ 6.7 (95%CI 3.7-10.9)) over bipolar amplitude alone (ROC 0.84), for predicting the presence of myocardial scar. No reliable correlation with the transmural extent of the scar was found.
S125 Conclusion: EGM characteristics in CARTO mapping correctly predict the presence of myocardial infarction scar assessed by MRI, but poorly inform on its’ transmural extent. Combined use of bipolar amplitude, duration and fragmentation enhances the diagnostic accuracy for the presence of the scar.
P1-55 5 YEARS-FOLLOW UP AFTER SUCCESSFUL PULMONARY VEIN ISOLATION FOR ATRIAL FIBRILLATION Thomas Arentz, MD, Reinhold Weber, MD, Gerd Bu¨rkle, MD, Thomas Blum, MD, Jochem Stockinger, MD and Dietrich Kalusche, MD. Herzzentrum, Bad Krozingen, Germany. Transseptal pulmonary vein (PV)-Isolation is a new and promising treatment of atrial fibrillation (AF). The question remains if this treatment is a curative. Methods: 30 patients (51⫾12 years, 7 women, 6 with organic heart disease) with complete elimination of AF (paroxysmal n⫽25, persistent n⫽5) without antiarrhythmic drugs 1 year after ostial segmental PVIsolation were re-examined 5 years after the initial procedure. The follow up visit included a questionnaire regarding symptoms of AF, 24 hours holter monitoring and event monitoring if necessary. Results: 27 of the 30 had no symptoms of AF and no AF during 24 hours holter monitoring without antiarrhythmic drug treatment. Three of the 27 patients had a second ablation procedure ⬎1 year (14⫾3 months) after the initial procedure for recurrence of AF (2⫻ for recovery of PV conduction and in one patients linear ablation had been performed at the roof of the LA and between the left lower PV and the mitral annulus). Three patients had recurrence of AF: 1 patient had persistent AF, and 2 rare episodes of paroxysmal AF under antiarrhythmic drug treatment. Conclusions: 27 of 30 Patients (90%) seem to be cured from AF after successful ostial segmental PV-Isolation. Six patients had recurrence of AF more than 1 year after the initial procedure, 3 of them were reablated successfully. P1-56 MAGNETIC CATHETER NAVIGATION IS SAFE AND EFFECTIVE FOR ABLATION OF SUPRAVENTRICULAR TACHYCARIDA: RESULTS OF THE MULTI-CENTER ATTRAC STUDY Bruce D. Lindsay, MD, Gery F. Tomassoni, MD, Vivek Y. Reddy, MD, Ruchir Sehra, MD, Karen J. Beckman, MD, Stanislav Weiner, MD, Katherine Warner, BS and Jason Zagrodsky, MD. Washington University School of Medicine, St. Louis, MO, Central Baptist Hospital, Lexington, KY, Massachusetts General Hospital, Boston, MA, Stereotaxis, Inc, St. Louis, MO, Oklahoma University Medical Center, Oklahoma City, OK, Tyler Cardiovascular Consultants, Tyler, TX, Stereotaxis, Inc., St. Louis, MO and Texas Cardiac Arrhythmia Research, Austin, TX. Introduction: Preliminary single site studies have demonstrated the feasibility of using the Magnetic Navigation System (MNS), Stereotaxis, Inc., for mapping and ablation of supraventricular tachycardia (SVT). This report summarizes results of the ATTRAC (Arrhythmia Treatment with a Thermocouple Radiofrequency Ablation Catheter) study, which is the first large, prospective, multi-center study to assess the safety and efficacy of the MNS in patients with common SVT or atrial fibrillation with a rapid rate that was difficult to control. Methods: Adults who required ablation of accessory pathways, AV nodal reentry, or the AV node were eligible. The ablation procedures were performed at 7 clinical sites with either a 1- (Helios I) or 3-magnet, thermocouple, 4mm tip RF ablation catheter (Helios II) designed for the MNS. Helios II was used in 90% of patients. They were followed for 3 months post ablation to assess long-term success. Results: 182 patients met the inclusion criteria for the study. There were 69