(Circulation. 1997;95:1611-1622.)
© 1997 American Heart Association, Inc.
Articles |
A Novel Method for Nonfluoroscopic Catheter-Based Electroanatomical Mapping of the Heart
In Vitro and In Vivo Accuracy Results
From the Cardiovascular System Laboratory, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
Correspondence to Shlomo A. Ben-Haim, MD, DSc, Cardiovascular System Laboratory, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron St, POB 9649, 31096 Haifa, Israel. E-mail sol{at}biomed.technion.ac.il.
Background Cardiac mapping is essential for understanding the mechanisms of arrhythmias and for directing curative procedures. A major limitation of the current methods is the inability to accurately relate local electrograms to their spatial orientation. The objective of this study was to present and test the accuracy of a new method for nonfluoroscopic, catheter-based, endocardial mapping.
Methods and Results The method is based on using a new locatable catheter connected to an endocardial mapping and navigating system. The system uses magnetic technology to accurately determine the location and orientation of the catheter and simultaneously records the local electrogram from its tip. By sampling a plurality of endocardial sites, the system reconstructs the three-dimensional geometry of the chamber, with the electrophysiological information color-coded and superimposed on the anatomy. The accuracy of the system was tested in both in vitro and in vivo studies and was found to be highly reproducible (SD, 0.16±0.02 [mean±SEM] and 0.74±0.13 mm) and accurate (mean errors, 0.42±0.05 and 0.73±0.03 mm). In further studies, electroanatomical mapping of the cardiac chambers was performed in 34 pigs. Both the geometry and activation sequence were repeatable in all pigs.
Conclusions The new mapping method is highly accurate and reproducible. The ability to combine electrophysiological and spatial information provides a unique tool for both research and clinical electrophysiology. Consequently, the main shortcomings of conventional mapping—namely, prolonged x-ray exposure, low spatial resolution, and the inability to accurately navigate to a predefined site—can all be overcome with this new method.
Key Words: mapping • catheter ablation • arrhythmia • electrophysiology
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E. C. Perin, G. V. Silva, R. Sarmento-Leite, A. L.S. Sousa, M. Howell, R. Muthupillai, B. Lambert, W. K. Vaughn, and S. D. Flamm Assessing Myocardial Viability and Infarct Transmurality With Left Ventricular Electromechanical Mapping in Patients With Stable Coronary Artery Disease: Validation by Delayed-Enhancement Magnetic Resonance Imaging Circulation, August 20, 2002; 106(8): 957 - 961. [Abstract] [Full Text] [PDF]
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P. A Friedman Novel mapping techniques for cardiac electrophysiology Heart, June 1, 2002; 87(6): 575 - 582. [Full Text] [PDF]
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L. L. Johnson, S. Thambar, T. Donahay, M. Dae, and D. O. Williams Effect of Endomyocardial Laser Channels on Regional Innervation Shown with 125I-MIBG and Autoradiography J. Nucl. Med., April 1, 2002; 43(4): 551 - 555. [Abstract] [Full Text] [PDF]
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F. Ouyang, R. Cappato, S. Ernst, M. Goya, M. Volkmer, J. Hebe, M. Antz, T. Vogtmann, A. Schaumann, P. Fotuhi, et al. Electroanatomic Substrate of Idiopathic Left Ventricular Tachycardia: Unidirectional Block and Macroreentry Within the Purkinje Network Circulation, January 29, 2002; 105(4): 462 - 469. [Abstract] [Full Text] [PDF]
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M. Boulos, I. Lashevsky, S. Reisner, and L. Gepstein Electroanatomic mapping of arrhythmogenic right ventricular dysplasia J. Am. Coll. Cardiol., December 1, 2001; 38(7): 2020 - 2027. [Abstract] [Full Text] [PDF]
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J M Edelberg, D T Huang, M E Josephson, and R D Rosenberg Molecular enhancement of porcine cardiac chronotropy Heart, November 1, 2001; 86(5): 559 - 562. [Abstract] [Full Text] [PDF]
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M. Gyongyosi, H. Sochor, A. Khorsand, L. Gepstein, and D. Glogar Online Myocardial Viability Assessment in the Catheterization Laboratory via NOGA Electroanatomic Mapping: Quantitative Comparison With Thallium-201 Uptake Circulation, August 28, 2001; 104(9): 1005 - 1011. [Abstract] [Full Text] [PDF]
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N Saoudi, F Cosio, A Waldo, S.A Chen, Y Iesaka, M Lesh, S Saksena, J Salerno, and W Schoels A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases. A Statement from a Joint Expert Group from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology Eur. Heart J., July 2, 2001; 22(14): 1162 - 1182. [PDF]
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T. Wolf, L. Gepstein, U. Dror, G. Hayam, R. Shofti, A. Zaretzky, G. Uretzky, U. Oron, and S. A. Ben-Haim Detailed endocardial mapping accurately predicts the transmural extent of myocardial infarction J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1590 - 1597. [Abstract] [Full Text] [PDF]
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P. R. Vale, D. W. Losordo, C. E. Milliken, M. C. McDonald, L. M. Gravelin, C. M. Curry, D. D. Esakof, M. Maysky, J. F. Symes, and J. M. Isner Randomized, Single-Blind, Placebo-Controlled Pilot Study of Catheter-Based Myocardial Gene Transfer for Therapeutic Angiogenesis Using Left Ventricular Electromechanical Mapping in Patients With Chronic Myocardial Ischemia Circulation, May 1, 2001; 103(17): 2138 - 2143. [Abstract] [Full Text] [PDF]
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J. K. Triedman, M. E. Alexander, C. I. Berul, L. M. Bevilacqua, and E. P. Walsh Electroanatomic Mapping of Entrained and Exit Zones in Patients With Repaired Congenital Heart Disease and Intra-Atrial Reentrant Tachycardia Circulation, April 24, 2001; 103(16): 2060 - 2065. [Abstract] [Full Text] [PDF]
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H. E. Botker, J. F. Lassen, F. Hermansen, H. Wiggers, P. Sogaard, W. Y. Kim, M. Bottcher, L. Thuesen, and A. K. Pedersen Electromechanical Mapping for Detection of Myocardial Viability in Patients With Ischemic Cardiomyopathy Circulation, March 27, 2001; 103(12): 1631 - 1637. [Abstract] [Full Text] [PDF]
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F. Anselme, A. Savoure, A. Cribier, and N. Saoudi Catheter Ablation of Typical Atrial Flutter : A Randomized Comparison of 2 Methods for Determining Complete Bidirectional Isthmus Block Circulation, March 13, 2001; 103(10): 1434 - 1439. [Abstract] [Full Text] [PDF]
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C. Reithmann, E. Hoffmann, U. Dorwarth, T. Remp, and G. Steinbeck Electroanatomical mapping for visualization of atrial activation in patients with incisional atrial tachycardias Eur. Heart J., February 1, 2001; 22(3): 237 - 246. [Abstract] [PDF]
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T. Wolf, L. Gepstein, G. Hayam, A. Zaretzky, R. Shofty, D. Kirshenbaum, G. Uretzky, U. Oron, and S. A. Ben-Haim Three-dimensional endocardial impedance mapping: a new approach for myocardial infarction assessment Am J Physiol Heart Circ Physiol, January 1, 2001; 280(1): H179 - H188. [Abstract] [Full Text] [PDF]
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D W. DAVIES Catheter ablation of ventricular tachycardia: are there limits? Heart, December 1, 2000; 84(6): 585 - 586. [Full Text]
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C. M. Tracy, M. Akhtar, J. P. DiMarco, D. L. Packer, H. H. Weitz, W. L. Winters, J. L. Achord, A. W. Boone, J. W. Hirshfeld Jr, B. H. Lorell, et al. American College of Cardiology/American Heart Association Clinical Competence Statement on invasive electrophysiology studies, catheter ablation, and cardioversion: A report of the american college of cardiology/american heart association/american college of physicians-american society of internal medicine task force on clinical competence J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1725 - 1736. [Full Text] [PDF]
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C. M. Tracy, M. Akhtar, J. P. DiMarco, D. L. Packer, H. H. Weitz, W. L. Winters, J. L. Achord, A. W. Boone, J. W. Hirshfeld Jr, B. H. Lorell, et al. American College of Cardiology/American Heart Association Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion : A Report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence Circulation, October 31, 2000; 102(18): 2309 - 2320. [Full Text] [PDF]
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H. Kottkamp, B. Hugl, B. Krauss, U. Wetzel, A. Fleck, G. Schuler, and G. Hindricks Electromagnetic Versus Fluoroscopic Mapping of the Inferior Isthmus for Ablation of Typical Atrial Flutter : A Prospective Randomized Study Circulation, October 24, 2000; 102(17): 2082 - 2086. [Abstract] [Full Text] [PDF]
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M.R. Boyett, H. Honjo, and I. Kodama The sinoatrial node, a heterogeneous pacemaker structure Cardiovasc Res, September 1, 2000; 47(4): 658 - 687. [Abstract] [Full Text] [PDF]
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C. Patterson and M. S. Runge Therapeutic Myocardial Angiogenesis Via Vascular Endothelial Growth Factor Gene Therapy : Moving on Down the Road Circulation, August 29, 2000; 102(9): 940 - 942. [Full Text] [PDF]
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P. R. Vale, D. W. Losordo, C. E. Milliken, M. Maysky, D. D. Esakof, J. F. Symes, and J. M. Isner Left Ventricular Electromechanical Mapping to Assess Efficacy of phVEGF165 Gene Transfer for Therapeutic Angiogenesis in Chronic Myocardial Ischemia Circulation, August 29, 2000; 102(9): 965 - 974. [Abstract] [Full Text] [PDF]
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R.J. Schilling, D.W. Davies, and N.S. Peters Clinical developments in cardiac activation mapping Eur. Heart J., May 2, 2000; 21(10): 801 - 807. [PDF]
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F. E. Marchlinski, D. J. Callans, C. D. Gottlieb, and E. Zado Linear Ablation Lesions for Control of Unmappable Ventricular Tachycardia in Patients With Ischemic and Nonischemic Cardiomyopathy Circulation, March 21, 2000; 101(11): 1288 - 1296. [Abstract] [Full Text] [PDF]
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