This case shows a patient who presented in AF for a cryoballoon PVI. After cardioversions were unsuccessful in restoring normal sinus rhythm (NSR) post-ablation, the Advisor™ HD Grid Mapping Catheter, SE was used to create a voltage and fractionation map.
After collecting geometry with the Advisor HD Grid Mapping Catheter, SE, it was discovered that the RIPV was missed during the cryoballoon ablation. What was thought to be the RIPV during the cryoballoon ablation was actually a middle branch. Substrate modification of highly fractionated zones was performed with RF ablation and NSR was restored.
This case shows a patient with a prior PVI who presented in atypical atrial flutter. Entrainment revealed the rhythm was most likely left atrial dependent. The Advisor HD Grid Mapping Catheter, SE was used to create a reentrant LAT map of the LA, and the critical isthmus was revealed on the anterior wall.
This case shows a patient with left atrial atypical flutter who underwent a previous AF ablation with no prior posterior wall ablation. The Advisor HD Grid Mapping Catheter, SE was used to create a reentrant LAT map of the LA. The flutter terminated after anchoring the existing line of block (black line) to the LIPV.
This case shows a patient who had a prior cryoablation PVI. Using Advisor HD Grid (assumption), two maps were created to reveal a double loop reentry atrial flutter and a focal tachycardia with the same cycle length.
This case shows a patient with left atrial atypical flutter. The Advisor HD Grid Mapping Catheter, SE was used to create a reentrant LAT map of the LA, and the critical isthmus was revealed at the antero-septal aspect location.
This case shows a patient who presented with incessant tachycardia after two prior PVI ablations. The Advisor HD Grid Mapping Catheter, SE was used to create an LAT map of the LA, which revealed a microreentrant circuit on the anterior wall of the LA. The tachycardia was terminated with the first RF lesion, and NSR was restored in the patient.
This case shows a patient who had a previous mitral isthmus line ablation. The patient presented in atrial flutter, and the Advisor HD Grid Mapping Catheter, SE was used to create a reentrant LAT map of the LA. SparkleMap was used to rapidly interpret the conduction dynamics of the circuit and to identify lines of block. SparkleMap helped to identify a critical deceleration zone (circled in yellow), which was a gap in the original lesion set.
The flutter terminated with RF ablation in the deceleration zone (orange lesion), starting at the mitral annulus and pulling back through the gap to anchor the lesion set to scar.
This case shows a patient who presented with AT. During pulmonary vein isolation (PVI) ablation, the Advisor HD Grid Mapping Catheter, SE was used to create an LAT map of the LA. The LAT map showed the AT was originating from the RA. The Advisor HD Grid Mapping Catheter, SE was then used to create an LAT map of the RA, which showed the earliest activation at the mid-lateral location of the RA. The focal AT was terminated with the first RF lesion, and NSR was restored in the patient.
This case shows a patient with a CRT-D device and ischemic VT. With RV only pacing, the Advisor™ HD Grid Mapping Catheter, Sensor Enabled™ was used to create a local activation timing (LAT) map with the Last Deflection algorithm (left) and voltage map (right). The maps show local abnormal ventricular activities (LAVA) EGMs on the basal septum in the LAT map (left) correlating with a posterior voltage channel in the voltage map (right).
Dr. Kim Rajappan utilizes the automated mapping capabilities of the EnSite Precision System combined with the Advisor HD Grid Mapping Catheter, SE, TactiCath™ Ablation Catheter, Sensor Enabled™, and Agilis™ NxT Steerable Introducer to perform pulmonary vein isolation. The procedure highlights the use of AutoMark software and the accuracy1 of the contact force TactiCath Ablation Catheter, Sensor Enabled.
In this video series, Dr. Paolo Della Bella showcases how he utilizes the high-resolution mapping capabilities of Advisor™ HD Grid Mapping Catheter, Sensor Enabled™ and the automated mapping tools of the EnSite Precision™ Cardiac Mapping System in an ischemic ventricular tachycardia (VT) procedure. The case highlights how to use EnSite™ AutoMap, Last Deflection, and HD Wave Solution™ Software in sinus rhythm to understand the significance of low voltage, late potentials.
Dr. Rod Tung combines the EnSite Precision System, Advisor HD Grid Mapping Catheter, SE and the ViewMate™ Z Intracardiac Ultrasound Console to approach a difficult septal substrate ventricular tachycardia (VT). The procedure highlights how advanced imaging can be coupled with high density mapping in both VT and sinus rhythm to characterize the 3D path of VT in the septal region.
1. Abbott. Data on File. Report 90430651.
Watch Dr. John D. Day present A Novel Multielectrode/Omnipolar Mapping Technology to Address the Limitations of Traditional Bipolar Mapping – Finding PV Gaps at AF Symposium 2019.
Watch Dr. John Day and Dr. Roger Winkle present the webinar High Density Mapping Using Novel #HDGrid for Pulmonary Vein Isolation (PVI)
Watch Dr. Rod Tung, Director of Cardiac Electrophysiology, University of Chicago Medicine, describe his use of Advisor™ HD Grid Cardiac Mapping Catheter, Sensor Enabled™ in VT mapping.
Caution: This product is intended for use by or under the direction of a physician. Prior to use, reference Instructions for Use, inside the product carton (when available) or at eifu.abbottvascular.com or at manuals.sjm.com for more detailed information on Indications, Contraindications, Warnings, Precautions and Adverse Events.
Indications: The Advisor™ HD Grid Mapping Catheter, Sensor Enabled™, is indicated for multiple electrode electrophysiological mapping of cardiac structures in the heart, i.e., recording or stimulation only. This catheter is intended to obtain electrograms in the atrial and ventricular regions of the heart. Contraindications: The catheter is contraindicated for patients with prosthetic valves and patients with left atrial thrombus or myxoma, or interatrial baffle or patch via transseptal approach. This device should not be used with patients with active systemic infections. The catheter is contraindicated in patients who cannot be anticoagulated or infused with heparinized saline.
Warnings: Cardiac catheterization procedures present the potential for significant x-ray exposure, which can result in acute radiation injury as well as increased risk for somatic and genetic effects, to both patients and laboratory staff due to the x-ray beam intensity and duration of the fluoroscopic imaging. Careful consideration must therefore be given for the use of this catheter in pregnant women. Catheter entrapment within the heart or blood vessels is a possible complication of electrophysiology procedures. Vascular perforation or dissection is an inherent risk of any electrode placement. Careful catheter manipulation must be performed in order to avoid device component damage, thromboembolism, cerebrovascular accident, cardiac damage, perforation, pericardial effusion, or tamponade. Risks associated with electrical stimulation may include, but are not limited to, the induction of arrhythmias, such as atrial fibrillation (AF), ventricular tachycardia (VT) requiring cardioversion, and ventricular fibrillation (VF). Catheter materials are not compatible with magnetic resonance imaging (MRI).
Precautions: Maintain an activated clotting time (ACT) of greater than 300 seconds at all times during use of the catheter. This includes when the catheter is used in the right side of the heart. To prevent entanglement with concomitantly used catheters, use care when using the catheter in the proximity of the other catheters. Maintain constant irrigation to prevent coagulation on the distal paddle. Inspect irrigation tubing for obstructions, such as kinks and air bubbles. If irrigation is interrupted, remove the catheter from the patient and inspect the catheter. Ensure that the irrigation ports are patent and flush the catheter prior to re-insertion. Always straighten the catheter before insertion or withdrawal. Do not use if the catheter appears damaged, kinked, or if there is difficulty in deflecting the distal section to achieve the desired curve. Do not use if the catheter does not hold its curve and/or if any of the irrigation ports are blocked. Catheter advancement must be performed under fluoroscopic guidance to minimize the risk of cardiac damage, perforation, or tamponade.
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