title: High-density circumferential pulmonary vein mapping with a 20-pole expandable circular mapping catheter.
abstract: The differentiation of pulmonary vein (PV) electrograms from atrial far-field signals during PV isolation (PVI) for atrial fibrillation (AF) may be difficult. In addition, owing to highly variable PV ostial sizes, current fixed-diameter circular PV mapping catheters may not yield optimal electrograms. We evaluated an expandable, circular 15-25 mm diameter, 20-pole mapping catheter for PV mapping during sustained AF in 25 patients. After selective PV angiography to define the ostial position and size, the catheter was introduced into each PV and withdrawn to the most stable proximal position, with optimal wall contact ensured by progressive loop expansion. At each PV ostium, electrograms recorded at high resolution (HR) were compared with those recorded at a resolution similar to that of a standard 10-pole Lasso catheter. After PVI performed during ongoing AF, the presence of residual far-field potentials (FFP) under both set-ups was compared. We mapped 97 PV, including 4 pairs with common ostia. In the HR recordings, the PV potentials had greater amplitude (0.5 +/- 0.1 vs 0.3 +/- 0.1 mV, P = 0.001) and fragmentation, whereas left atrial FFP were minimized. After successful isolation of all PV, FFP were observed in 33% of left superior and 28% of left inferior PV on the HR recordings, compared to 66% and 61%, respectively under normal resolution. Catheter stability and optimal wall contact, in combination with HR electrograms can optimize circumferential PV mapping during AF and improve the discrimination of FFP postablation.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France. hsulifern@yahoo.com.sg
authors.forename: Li-Fern
authors.initials: LF
authors.lastname: Hsu
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.forename: Martin
authors.initials: M
authors.lastname: Rotter
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Christophe
authors.initials: C
authors.lastname: Scavée
authors.forename: Frederic
authors.initials: F
authors.lastname: Sacher
authors.forename: Jacques
authors.initials: J
authors.lastname: Clémenty
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D001281:Atrial Fibrillation / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation; D002404:Catheterization; D004566:Electrodes; D004594:Electrophysiology; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000473:pathology* / Q000503:physiopathology