Use of advanced mapping systems to guide ablation in complex cases: experience with noncontact mapping and electroanatomic mapping systems.
OBJECTIVE
This report describes our experience with noncontact mapping and electroanatomic mapping in complex ablations, which are defined as ablations done after failure of conventional ablation.


METHODS
Patients were included (N = 68; 49% with structural heart disease) in whom previous ablation failed and in whom a second procedure was done with advanced mapping. Non-contact mapping was used in 17 patients, electroanatomic mapping in 36, and both noncontact and electroanatomic mapping in 15. Arrhythmias included focal atrial tachycardia (n = 16), reentrant atrial tachycardia (n = 14), right ventricular outflow tachycardia (n = 10), post-myocardial infarction ventricular tachycardia (n = 9), and others (n = 19).


RESULTS
Acute success at the second ablation was achieved in 79% of patients. At 20 +/- 9 months after the procedure, 69% of these patients reported having significantly fewer symptoms than before the second ablation, and 51% were free of symptoms. Only 16% were using antiarrhythmic medications. Complications included a small pericardial effusion in two patients, hypotension in one patient, and a femoral pseudoaneurysm in another.


CONCLUSIONS
Advanced mapping is a useful and safe adjunct for catheter ablation after ablation has failed in patients with complex substrate.
Gurevitz
Osnat T
OT
Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Glikson
Michael
M
Asirvatham
Samuel
S
Kester
Tammy A
TA
Grice
Suellen K
SK
Munger
Thomas M
TM
Rea
Robert F
RF
Shen
Win-Kuang
WK
Jahangir
Arshad
A
Packer
Douglas L
DL
Hammill
Stephen C
SC
Friedman
Paul A
PA
D001145:Arrhythmias, Cardiac / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D016896:Treatment Outcome