SuperMap algorithm: an efficient, safe and accurate modality for mapping and eliminating challenging cardiac arrhythmias.

Even with the development of advanced catheter-based mapping systems, there remain several challenges in the electrophysiological evaluation and elimination of atrial arrhythmias. For instance, atrial tachycardias with irregular rates cannot be reliably mapped by systems that require stability in order to sequentially gather data points to be organized thereafter. Separately, these arrhythmias often arise following initial ablation for atrial fibrillation, posing logistic challenges. Here, we present the available literature summarizing the use of a non-contact mapping catheter, the AcQMap catheter, in conjunction with SuperMap, an algorithm that compiles a large number of non-contact data points from multiple catheter positions within the atria. These studies demonstrate the efficiency, safety and accuracy of this technology.

Irregular heart rhythms (arrhythmias) are often treatable with medications, but sometimes require expert evaluation in a cardiac electrophysiology laboratory. They are often studied and treated using thin, flexible catheters which enter the body through blood vessels in the leg and reach the internal walls of the heart. Time, expertise and specialized equipment are necessary to identify characteristics specific to each patient's arrhythmia. For each arrhythmia, a unique electrical blueprint is created before trying to eliminate it. The fleeting nature of certain arrhythmias can make it difficult to generate these blueprints, and many take a lot of time to accurately identify, leading to procedural challenges. Here we evaluate studies discussing the use of a new catheter (AcQMap) and its accompanying strategy for identifying arrhythmias. Unlike traditional catheters that require direct contact with the internal walls of the heart, the AcQMap catheter floats within these blood-filled chambers and does not touch the walls when obtaining data points. Instead, using ultrasound waves and electrical signals, it can generate data points to create blueprints. This technology also uses a new algorithm that enables the catheter to move freely within the heart, obtaining numerous data points and grouping them together to create maps efficiently and safely, even for fleeting or challenging arrhythmias.

The use of balloon atrial septostomy to facilitate difficult transseptal access in patients undergoing catheter ablation for atrial fibrillation.

INTRODUCTION: With the increasing number of patients undergoing repeat catheter ablation procedures for atrial fibrillation, it is not uncommon to encounter a fibrotic interatrial septum that resists the conventional manual advancement of the transseptal sheath. Forceful advancement of the transseptal apparatus can reduce fine control and potentially lead to a higher rate of perforation. CASE: We report a case where adjunctive balloon atrial septostomy was used to facilitate transseptal access in a patient with fibrotic interatrial septum. Using a small-caliber angioplasty balloon and under direct fluoroscopic and transesophageal echocardiogram visualization, balloon septostomy was performed with hand inflation until a "waist" was seen. This technique provides a safe way to control the size of the transseptal access created, and allows the passage of a relatively soft-tipped transseptal sheath across a resistive septum. To our knowledge this is the first published use of balloon atrial septostomy during transseptal puncture for left atrium access in a catheter ablation procedure. CONCLUSION: Balloon atrial septostomy should be considered as an alternative technique for safe transseptal cannulation in select patients in the electrophysiology laboratory or other interventional procedures requiring left atrial access or delivery of large-caliber catheters or sheaths.

Homocysteine hypothesis for atherothrombotic cardiovascular disease: not validated.

Homocysteine has been implicated in promoting atherosclerotic and thrombotic vascular disease. During the last decade, the utility of homocysteine in predicting risk for atherothrombotic vascular disease has been evaluated in several observational studies in a large number of patients. These studies show that the overall risk for vascular disease is small, with prospective, longitudinal studies reporting a weaker association between homocysteine and atherothrombotic vascular disease compared to retrospective case-control and cross-sectional studies. Furthermore, randomized controlled trials of homocysteine-lowering therapy have failed to prove a causal relationship. On the basis of these results, there is currently insufficient evidence to recommend routine screening and treatment of elevated homocysteine concentrations with folic acid and other vitamins to prevent atherothrombotic vascular disease. This review outlines the metabolism and pathophysiology of homocysteine, highlights the results of homocysteine observational and interventional trials, and presents areas of uncertainty and potential future work.