Pulmonary vein isolation using the Rhythmia mapping system: Verification of intracardiac signals using the Orion mini-basket catheter

Heart Rhythm. 2015 Sep;12(9):1927-34. doi: 10.1016/j.hrthm.2015.05.019. Epub 2015 May 19.

Abstract

Background: During pulmonary vein isolation (PVI), a circular lasso catheter is positioned at the junction between the left atrium (LA) and the pulmonary vein (PV) to confirm PVI. The Rhythmia mapping system uses the Orion mini-basket catheter with 64 electrodes instead of the lasso catheter. However, its feasibility to determine PVI has not been studied.

Objective: The purpose of this study was to compare signals between the mini-basket and lasso catheters at the LA-PV junction.

Methods: In 12 patients undergoing PVI using Rhythmia, the mini-basket and lasso catheters were placed simultaneously at the LA-PV junction for baseline and post-PVI signal assessment. Pacing from both catheters was performed to examine the presence of exit block.

Results: At baseline, recordings of LA and PV potentials were concordant in all PVs. However, after PVI, concordance between the catheters was only 68%. Discordance in all cases resulted from loss of PV potentials on the lasso catheter with persistence of PV potentials on the mini-basket catheter. In 9 of 13 PVs (69%), these potentials represented true PV potentials that were exclusively recorded with the smaller and closely spaced mini-basket electrodes. In the other 4 PVs (31%), these potentials originated from neighboring structures and resulted in underestimation of PVI.

Conclusion: The use of the mini-basket catheter alone is sufficient to determine PVI. While it improves recording of PV potentials after incomplete ablation, it is also associated with frequent recording of "PV-like" potentials originating from neighboring structures. In these cases, pacing maneuvers are helpful to determine PVI and avoid excessive ablation.

Keywords: Atrial fibrillation; Basket catheter; Lasso; Orion; Pulmonary vein isolation; Rhythmia.

MeSH terms

  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / surgery*
  • Body Surface Potential Mapping / instrumentation*
  • Cardiac Catheterization / instrumentation*
  • Catheter Ablation
  • Catheters*
  • Equipment Design
  • Female
  • Follow-Up Studies
  • Heart Atria / physiopathology*
  • Heart Conduction System / physiopathology
  • Heart Conduction System / surgery*
  • Humans
  • Male
  • Middle Aged
  • Miniaturization
  • Prospective Studies
  • Pulmonary Veins / surgery*
  • Time Factors
  • Treatment Outcome