title: Use of advanced mapping systems to guide ablation in complex cases: experience with noncontact mapping and electroanatomic mapping systems.
abstract: 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.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Osnat T
authors.initials: OT
authors.lastname: Gurevitz
authors.forename: Michael
authors.initials: M
authors.lastname: Glikson
authors.forename: Samuel
authors.initials: S
authors.lastname: Asirvatham
authors.forename: Tammy A
authors.initials: TA
authors.lastname: Kester
authors.forename: Suellen K
authors.initials: SK
authors.lastname: Grice
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Munger
authors.forename: Robert F
authors.initials: RF
authors.lastname: Rea
authors.forename: Win-Kuang
authors.initials: WK
authors.lastname: Shen
authors.forename: Arshad
authors.initials: A
authors.lastname: Jahangir
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Packer
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hammill
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
mesh_terms: 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