RESUMO
BACKGROUND: Atrial Fibrillation ablation in older patients represents a challenge to be addressed to ensure the improvement of the quality of life and survival of these patients. New mapping system tools can help to treat older patients because of its ability to simplify and reduce procedural risks. The new NavX EnSite "Live view" tool allows dynamic "beat to beat" activation and voltage mapping visualization in order to instantly recognize vein disconnection and minimize RF deliveries. METHODS: An 81-year old patient with paroxysmal AF and well-documented firing focus trigger underwent pulmonary veins isolation using NavX EnSite Precision, HD Grid multipolar catheter, and the new "Live view" tool. RESULTS: All pulmonary veins were successfully isolated with no procedural complications. "Live view" tool allows to perform shorter and safer procedure (total procedural time: 90 minutes, left atrium dwell time: 60 minutes, total RF delivery number: 78). CONCLUSION: "Live view tool" allows dynamic activation and voltage mapping in order to perform a safe and tailored approach to ablation, especially in older patients.
RESUMO
BACKGROUND: Substrate analysis of the left atrium in patients undergoing atrial fibrillation ablation has limitations when performed by means of simple bipolar acquisition. OBJECTIVE: To evaluate the incidence of low-voltage zones (LVZs) through maps constructed by means of various catheters: multipolar (MC), omnipolar (OC), and circular catheters (CMCs) with the 3D electro-anatomical systems (3d-S) CARTO3 and EnSite Precision. METHODS: To assess LVZs, we acquired maps by means of CMC and MC in the voltage range 0.05-0.5 mV in 70 consecutive patients in sinus rhythm. In the case of OC only, we made an intra-patient comparison of bipolar maps constructed by means of the along and across, and HD-Wave configurations of the EnSite 3d-S in the ranges of 0.05-0.5 and 0.5-1.0 mV. On the basis of this comparison, we chose the range that best identified LVZs as a set of different colors (SDC) compatible with patchy fibrosis (qualitative analysis). Subsequently, we detected the voltage values corresponding to purple and gray points, close to SDC, and the value inside corresponding to blue, green, and red colors, and we evaluated the color change in other voltage ranges. Finally, we performed a quantitative analysis of LVZs by applying the qualitative characteristics described above. RESULTS: On the basis of our settings, for OC, the optimal range identifying LVZs was 0.3-0.6 mV. OC revealed smaller LVZs than MC (P < .05 or P < .001), except in the lateral wall. No significant differences were observed between CMCs. CONCLUSIONS: In our experience, OC does not present the limits of bipolar HD maps, though further studies are needed in order to confirm that 0.3-0.6 mV is the optimal voltage range within which to identify LVZs.