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Impact of respiration on electroanatomical mapping of the right atrium: implication for cavotricuspid isthmus ablation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFL) has become the preferred treatment for this arrhythmia. The aims of this study were to assess the impact of respiratory gating (RG) on electroanatomical mapping of CTI and to assess the efficiency of CTI ablation guided by the Carto3® system equipped with the new respiration gating software.

Methods

Forty-four consecutive patients (mean age, 60 ± 13 years; 25 male) undergoing cavotricuspid ablation for symptomatic common AFL were randomly assigned to CARTO™ mapping with or without enabling RG module (Group A, RG OFF, Group B, RG ON).

Results

A significant reduction in mean RA volume, CTI central length and CS ostium maximum diameter has been observed in the RG maps. The mean total procedural, fluoroscopy and radiofrequency (RF) time were 102.9 ± 35.3, 10.6 ± 3.3, 22.9 ± 14.2 min in group A and 75.3 ± 21.7, 3.6 ± 4.5, 10.4 ± 5.7 min in group B, respectively (p < 0.05).

Conclusions

Electroanatomical mapping systems’ accuracy may be strongly influenced by respiration movements. The current study showed that automatic respiratory gated acquisition resulted in a better visualization of CTI, and this determines a relevant reduction in fluoroscopy and RF times.

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Abbreviations

CTI:

Cavotricuspid isthmus

AFL:

Atrial flutter

EAM:

Electroanatomical mapping/map

FAM:

Fast anatomical mapping

RA:

Right atrium

LA–PV:

Left atrium–pulmonary vein

RG:

Respiratory gating

CS:

Coronary sinus

RTG:

Real-time graph

RF:

Radiofrequency

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Conflict of interest

Ermenegildo de Ruvo received consulting honoraria from Biosense Webster, Inc.; Serena Dottori is an employee of Biosense Webster Inc. No financial or other relations that could lead to a conflict of interest is present for other authors.

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Authors and Affiliations

  1. Division of Cardiology, Policlinico Casilino, ASL RM/B, Rome, Italy

    Ermenegildo de Ruvo, Luigi Sciarra, Marco Rebecchi, Borrelli Alessio, Scarà Antonio, Lucia De Luca, Anna Maria Martino, Fabrizio Guarracini, Alessandro Fagagnini, Ernesto Lioy & Leonardo Calò

  2. Biosense Webster Inc. Italy, Milan, Italy

    Serena Dottori

  3. Via A. Cassani 32, 00046, Grottaferrata, Rome, Italy

    Ermenegildo de Ruvo

Authors
  1. Ermenegildo de Ruvo
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  2. Serena Dottori
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  3. Luigi Sciarra
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  4. Marco Rebecchi
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  6. Scarà Antonio
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  11. Ernesto Lioy
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Correspondence to Ermenegildo de Ruvo.

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Editorial Commentary

In a randomized study De Ruvo et al. evaluated the impact of respiratory gating on electroanatomical mapping of the cavo-tricuspid isthmus (CTI) region during catheter ablation of typical atrial flutter. The authors showed a reduction of CTI central length and right atrial volume. Furthermore a reduction of fluoroscopy and radiofrequency times was also reported. Whether such benefits translate in better long-term freedom from recurrent arrhythmia is unclear.

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de Ruvo, E., Dottori, S., Sciarra, L. et al. Impact of respiration on electroanatomical mapping of the right atrium: implication for cavotricuspid isthmus ablation. J Interv Card Electrophysiol 36, 33–40 (2013). https://doi.org/10.1007/s10840-012-9745-7

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  • DOI: https://doi.org/10.1007/s10840-012-9745-7

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