The anatomical determinants for the design of intracardiac mapping and ablation catheters.
An important factor in the efficient and successful completion of the ablation procedure is the design characteristics of the mapping/ablation catheters. These procedures are often hampered by the inability to maneuver the catheter to the desired location, in part because the catheters only have a single plane deflection capability and are not designed for the specific cardiac anatomical structures that contain the arrhythmogenic substrate. Single and Biplane Deflectable Catheters: Using measurements taken from six normal human cadaver hearts, ablation catheter design characteristics are presented for posterior, posterior septal, lateral, and posterior lateral pathways for retrograde and transseptal approaches. Three catheter designs based on anatomical characteristics were also evaluated. Pigtail Catheter: This catheter adapts to the atrial side of the mitral ring and improves positioning and stability for mapping and ablation of left-sided accessory pathways. Loop Catheter: This catheter is positioned at the perivalvular tricuspid ring and provides simultaneous mapping and ablation capabilities without the need to move the catheter or the need for additional catheters. Rotating Tip Catheter: The tip of this catheter is made up of three elongated teeth, which were curved 120 degrees apart into the rotating tip electrode. This electrode was designed to negotiate the surfaces of the atrial and intraventricular chambers. It is capable of discrete movements and has a large electrode-tissue contact area for the ablation of atrial and ventricular arrhythmias. Catheter designs presented in this article are based on the ability of the catheter to adapt to the anatomical location of the arrhythmogenic tissue as well as the maneuverability of the catheter's mapping and ablation electrodes. An anatomical approach to the design of ablation catheter technology is likely to reduce the x-ray radiation exposure for patient and operator, and may further increase the success rate of the procedure.
Avitall
B
B
Electrophysiology Research Laboratory, University of Wisconsin-Milwaukee Clinical Campus, Sinai Samaritan Medical Center 53201.
Hare
J
J
Krum
D
D
Dhala
A
A
D000818:Animals; D001021:Aortic Valve / Q000033:anatomy & histology; D001283:Atrioventricular Node / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery; D002036:Bundle of His / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery; D017115:Catheter Ablation / Q000295:instrumentation*; D004285:Dogs; D004562:Electrocardiography / Q000295:instrumentation*; D004594:Electrophysiology / Q000295:instrumentation; D004867:Equipment Design; D006321:Heart / Q000033:anatomy & histology*; D006325:Heart Atria / Q000033:anatomy & histology / Q000601:surgery; D006346:Heart Septum / Q000033:anatomy & histology; D006352:Heart Ventricles / Q000033:anatomy & histology / Q000601:surgery; D006801:Humans; D008943:Mitral Valve / Q000033:anatomy & histology; D012399:Rotation; D012849:Sinoatrial Node / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery; D013499:Surface Properties; D014261:Tricuspid Valve / Q000033:anatomy & histology