A month after the procedure, the patient received a DDD pacemaker (St. After a 30‐min waiting time, reduced frequency was maintained. Reduction of frequency was obtained with a maximal heart rate of 90 beats per minute under isoprenaline administration. This clearly highlights the advantages of an improved spatial resolution. Interestingly enough, at the earliest spot depicted by AcQMap, there was no phrenic nerve captured.
The earliest site was assessed and ablation was performed using the following power settings: 55W, 43C, 30 ml/min, with a total number of 15 applications and a 7‐min fluoroscopy time. Under intravenous infusion of isoprenaline, a dipole change density map of the sinus node region using AcQMap mapping system was performed. The procedure was performed under local anesthesia. Shortly after the procedure, the patient experienced recurrences and was rescheduled for ablation using the AcQMap system. Despite this, the procedure resulted in 10% reduction in sinus node frequency. Unfortunately at the earliest activation site, the phrenic nerve was detected and no further ablations were applied to this area. Ablation was performed with 10 RF applications using the following power settings: 45W, 43C, and 17 ml/min. All arrhythmia substrates (concealed bypass, slow pathway, atrial tachycardia) were excluded and she underwent sinus node modification using the CARTO system. Due to a quasi‐continuous sinus tachycardia, (average heart rate between 143 and 154 bpm) despite beta‐blocker and ivabradine treatment she was referred for an EP study in 2020.
Carto system series#
The aim of this case series draws attention to the possible benefit of using AcQMap mapping system in the mapping of IAST in highly symptomatic patients.Ī 29‐year‐old woman patient, presenting palpitations and vasovagal syncope, has been experiencing disabling symptoms since 2013 and received an ILR device (Medtronic, Reveal LINQ) in 2015. By offering a global endocardial three‐dimensional anatomical map combined with high‐resolution charge density maps of electrical activation, the AcQMap mapping system may offer advantages as compared with the currently used sequential mapping techniques. 4 Due to the unique technological features, this mapping technology has the potential of increasing both short‐term and long‐term outcomes in patients even with uncommon arrhythmias.
With the introduction of novel mapping technologies, such as dipole charge density mapping, the possibility of successful mapping and ablation in challenging arrhythmias are instantaneously improving. The major limitation of the currently used standard mapping techniques include suboptimal spatial and temporal resolution. 3 Beyond the very well protected epicardial anatomical position, recurrences could also be related to the suboptimal mapping of the targeted region. 2 Mapping and CA of IAST results in reasonably good primary success, however, it has high recurrence rate among patients requiring multiple redo procedures. 1 Although the prevalence of IAST is relatively low, in selected patients it may require catheter ablation (CA). Inappropriate sinus tachycardia (IAST) is an uncommon form of supraventricular arrhythmia defined by inexplicably high sinus node frequency at rest or at minimal physical activity. We aim to demonstrate the crucial benefit of this novel technique for the ultimate success of eliminating IAST. Three unique catheter ablation patients of symptomatic inappropriate sinus tachycardia underwent an initial ablation procedure using classical sequential mapping system (CARTO), and a redo procedure using a novel noncontact mapping system (AcQMap).
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