[Non-fluoroscopic electroanatomical mapping (CARTO system) in the ablation of atrial tachycardias].
OBJECTIVE
The recent introduction of navigation systems has made substantial improvements in cardiac electrophysiological mapping. We present our experience with non-fluoroscopic electroanatomical mapping in patients with atrial tachycardias.


METHODS
We studied 24 consecutive patients with atrial tachycardias (10 of whom had undergone previous radiofrequency ablation which failed). In all patients we performed electroanatomical mapping of the atria with the CARTO system, which combines electrophysiological and spatial information and allows visualization of atrial activation in a three-dimensional anatomical reconstruction of the atrial cavity. Mapping was performed during tachycardia (22 patients) or in sinus rhythm (2 patients), using a left atrial approach in 12 patients. Cooled-tip ablation was performed in 3 patients.


RESULTS
Three-dimensional mapping distinguished clearly and rapidly between reentrant (9 patients) and focal mechanisms (15 patients). Radiofrequency catheter ablation was aimed at the critical isthmus of conduction (voltage maps) in patients with macroreentrant tachycardias. For focal tachycardias the catheter was re-navigated within the target area (activation maps) to the earliest focus of ectopic impulses. Acute success was obtained in 19 patients (79.2%), with early recurrence in 2 of them. Fluoroscopy time was 60 (21 min).


CONCLUSIONS
Visualization of atrial activation in a three-dimensional reconstruction of the atria with the CARTO electroanatomical mapping system facilitated the integration of electrophysiological and anatomical information in patients with atrial tachycardias. This technique is potentially helpful in ensuring successful treatment of the substrate of tachycardia in this selected group of patients.
González-Torrecilla
Esteban
E
Sección de Electrofisiología y Arritmias. Servicio de Cardiología. Hospital General Universitario Gregorio Marañón. Madrid. España. etorrecilla@jet.es
Arenal
Angel
A
Quiles
Juan
J
Atienza
Felipe
F
Jiménez-Candil
Javier
J
del Castillo
Silvia
S
Almendral
Jesús
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D002648:Child; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery; D006329:Heart Conduction System / Q000033:anatomy & histology / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013612:Tachycardia, Ectopic Atrial / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome