Clin Res Cardiol 101, Suppl 1, April 2012

V103 - Catheter Ablation of Ventricular Tachycardia Using a New Non-Fluoroscopic Sensor-Guided ā€œ4Dā€ Navigation Tool (MediGuideTM)
 
S. Rolf1, P. Sommer1, T. Gaspar1, A. Arya1, E. Koutalas1, G. Hindricks1, C. Piorkowski1
 
1Abt. für Rhythmologie, Herzzentrum der Universität Leipzig, Leipzig;
 
Purpose: A novel sensor-based electromagnetic 3D navigation system has been introduced that allows real-time catheter tracking in the environment of pre-recorded conventional 2D X-ray loops (MediGuide (MG) Technology, SJM). We report the first clinical experience for catheter ablation of ventricular tachycardia (VT) and extrasystoles (VES).
Methods: The new MG catheter tracking technology was used for VT mapping and ablation in 7 pts. with non/ischemic cardiomyopathy and 3 pts. with idiopathic right ventricular outflow tract VES. In 3 pts. the system was used for ventricular mapping w/o further ablation due to noninducibility (10 male patients, age 65 ± 13 yrs.). At the beginning of the procedure, left or right ventricular angiographies were recorded in at least two angulations. These moving images were used as background movies for non-fluoroscopic catheter tracking. Consequently, the system allows for “4D” nonfluoroscopic catheter tracking, because the sensors are visualized on two MG screens simultaneously. Steerable MG-enabled diagnostic EP catheters were used for non-fluoroscopic placement of diagnostic catheters, tagging of defined anatomical structures within the MG system, and anatomical  reconstruction plus voltage mapping of the relevant heart chamber within the electro-anatomic mapping system (EAMS). Pacing and entrainment maneuvers as well as activation mapping - when hemodynamically tolerable - were performed with a conventional open-irrigated tip catheter.
Results: In all 13 patients the MG-enabled catheters could reliably and safely be non-fluoroscopically visualized in real-time throughout the procedure. Nonfluoroscopic 4D catheter tracking significantly improved the heart chamber reconstruction and mapping process (8x left ventricle, 7x right ventricle, 1x epicardium, 1x mid cardiac vein). EAMS field scaling based on MG data helped to create realistic EAMS maps. In pts. with VT ablation occurring in the setting of structural heart disease, procedural times were 175±35 min, fluoroscopy times were 45±14 min, and procedural success (noninducibility of any VT) was achieved in 71%. In pts. with idiopathic VT ablation, procedural parameters were 128±11 min, 14±3 min, and 100% respectively. Side effects: 1 tamponade occurring at the end of a ischemic VT procedure, and 1 pseudoaneurysm requiring surgical repair.
Conclusions: With the first cases reported so far, we could show that the new sensor-guided technology allowed for reliable and safe non-fluoroscopic biplane catheter tracking within prerecorded 2D cine loops in the setting of ventricular arrhythmias. The “4D” catheter navigation in particular has the potential to improve mapping within complex moving heart chambers.
 
Clin Res Cardiol 101, Suppl 1, April 2012
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-012-1100-6

http://www.abstractserver.de/dgk2012/ft/abstracts/V103.htm