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CARDIOVASCULAR
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Advisor™ HD Grid Mapping Catheter, SENSOR ENABLED™ Case Images

 

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Voltage and Fractionation Map

ATRIAL FIBRILLATION (AF)

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.

Image courtesy of Dr. Thomas Crawford (University of Michigan Hospital and Health Center | Ann Arbor, MI)

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Voltage Map (Left) and Posterior Isolation of Right Veins RF Ablation (Right)
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Post-ablation Restored to NSR

Atrial Fibrillation

This patient presented in persistent AF for a cryoballoon PVI. After four unsuccessful cardioversions post ablation, the Advisor HD Grid Mapping Catheter, SE was used to create a voltage map. The roof and right veins were still active, so a roof line and posterior isolation of right veins was performed with RF ablation. Patient was still in AF. A signal of 0.03 mV was picked up on the Advisor HD Grid Mapping Catheter, SE in the right carina, possibly from epicardial fibers. Upon ablation, the patient had a 12 sec conversion pause and restored to NSR.

Image courtesy of Dr. David Kenigsberg (Westside Regional Medical Center | Plantation, FL)

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Reentrant LAT Map of the LA

Left Atrial Atypical Flutter

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.

Image courtesy of Dr. Farhat Khairallah (Tallahassee Memorial Healthcare | Tallahassee, FL)

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Reentrant LAT Map of the LA

LEFT ATRIAL ATYPICAL FLUTTER

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.

Image courtesy of Dr. Bohuslav Finta (Lutheran Medical Center | Wheat Ridge, CO)

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LA Atypical Flutter Activation Map
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LA Atypical Flutter Activation Map

LEFT ATRIAL ATYPICAL FLUTTER

This patient had undergone a previous RF PVI as well as mitral valve surgery involving a LAA resection. The patient presented in persistent atypical flutter with all veins isolated. Advisor HD Grid Mapping Catheter, SE was used to map the entire LA. Localized reentry was noted at the area of the LAA resection with near continuous activation on the B spline. The tachycardia terminated immediately upon RF ablation in that area.

Image courtesy of Dr. Benzy Padanilam (St. Vincent Indianapolis Hospital | Indianapolis, IN)

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Atypical AFL & AT

Atypical AFL & AT

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.

Image courtesy of Dr. Abdul Alawwa (McLaren Regional Medical Center | Flint, MI)

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Reentrant LAT Map of the LA

Left Atrial Antero-Septal Atypical Flutter

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.

Image courtesy of Dr. Rod Passman (Northwestern Memorial Hospital | Chicago, IL)

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LAT Map of the LA

Left Atrial MICROREENTRANT TACHYCARDIA

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.

Image courtesy of Dr. Jeffrey A. Olson (St. Vincent Hospital | Indianapolis, IN)

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LAT Map of the LA

LIPV Isolation Following Acute Gap Identification Post WACA for Paroxysmal Atrial Fibrillation

The case image was generated during a paroxysmal PVI ablation. The map shown was collected after the initial WACA lesion set did not fully isolate the left pulmonary vein sleeve. Advisor HD Grid Mapping Catheter, SE was used to map a discreet anterior connection into the LIPV/Left vein sleeve. The first RF application at the white early isochrone electrically isolated the sleeve, upon which exit block was confirmed with antral pacing via Advisor HD Grid Mapping Catheter, SE. Total procedure time was competed in approximately 80 minutes.

Image courtesy of Dr. Christopher Woods (Mills-Peninsula Medical Center | Burlingame, CA)

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Reentrant LAT Map of the LA with SparkleMap

Redo Mitral Flutter

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.

Image courtesy of Dr. Shaun Cho (El Camino Hospital | Palo Alto, CA)

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LAT Map SHOWING POINT DENSITY - RA
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LAT Map of the RA

Right Atrial Focal AT

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.

Image courtesy of Dr. Steven Fowler (Community Hospital of the Monterey Peninsula | Monterey, CA)

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LAT map with the Last Deflection algorithm
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Voltage Map

Ischemic VT

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).

Image courtesy of Dr. John Nguyen (Mercy Hospital | Coon Rapids, MN)

Clinical Case Reviews

Initial Experience: EnSite™ LiveView Dynamic Display

Dr. Takanori Yamaguchi (Japan) and Prof. Peter Kistler (Australia) share Initial Case Experiences utilizing the EnSite™ LiveView Dynamic Display

 
Introduction

Close the Gap Data

Comparison of Gap Identification Using Three Technologies for Confirmation of Pulmonary Vein Isolation
Dr. Frédéric Sebag

Dr. Frédéric Sebag (Paris, France) discusses the Comparison of Gap Identification Using Three Technologies for Confirmation of Pulmonary Vein Isolation.

Comparison of Gap Identification Using Three Technologies for Confirmation of Pulmonary Vein Isolation
Prof. Dr. Lukas Dekker

Prof. Dr. Lukas Dekker (Eindhoven, The Netherlands) discusses the Incidence and Location of PVI Gaps Identified Post-Cryoballoon Ablation for Atrial Fibrillation.

Comparison of Gap Identification Using Three Technologies for Confirmation of Pulmonary Vein Isolation
Prof. Daniel Steven

Prof. Daniel Steven (Cologne, Germany) discusses the Incidence and Location of Residual Gaps Identified by a High-Density Grid-Style Mapping Catheter after PVI is Confirmed by Pacing the Ablation Line.

Live Case Reviews

Atrial Fibrillation

Kim Rajappan, MD | John Radcliffe Hospital, Oxford UK

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.

 
 
 
 
Introduction
Introduction
Transseptal Puncture
Transseptal Puncture
Left-Sided Vein Isolation
Left-Sided Vein Isolation
Right-Sided Vein Isolation
Right-Sided Vein Isolation
Geo-Building
Geo-Building
Re-Mapping
Re-Mapping

Ventricular Tachycardia

Paolo Della Bella, MD | San Raffaele Hospital, Milan Italy

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.

 
 
 
Case Introduction
Case Introduction
Della Bella - Ablation
Ablation
Sinus Rhythm Mapping with Advisor HD Grid Catheter, SE
Sinus Rhythm Mapping with Advisor HD Grid Mapping Catheter, Sensor Enabled
Sinus Rhythm Mapping with Flexability Ablation Catheter, SE
Sinus Rhythm Mapping with Flexability Ablation Catheter, Sensor Enabled
Re-Mapping and Final Remarks
Re-Mapping and Final Remarks
Roderick Tung, MD | University Of Chicago Medicine, Chicago USA

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.

 
 
 
 
Introduction and Workflow Set-Up
Introduction and Workflow Set-Up
Access and ICE Visualization
Access and ICE Visualization
VT Mapping with Advisor™ HD Grid Catheter, SE
VT Mapping with Advisor HD Grid Mapping Catheter, Sensor Enabled
Ablation
Ablation Strategies
Review of Case and Summary
Review of Case and Summary
References

1. Abbott. Data on File. Report 90430651.

Physician Testimonials

Dr. John Day Discusses Finding PV Gaps
Dr. John Day And Dr. Roger Winkle Discuss High Density Mapping For PVI
Dr. Rod Tung Describes VT Mapping

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.

Patient Testimonials

Learn How One AF Patient Got Back His Quality of Life

The Advisor™ HD Grid Mapping Catheter, Sensor Enabled™ is helping physicians see things differently in Atrial Fibrillation (AF) ablation.

Hear Gottfried's story and experience living with Atrial Fibrillation and how a procedure using advanced mapping technology performed by Professor Helmut Pürerfellner (Elisabethinen Hospital, Linz, Austria) allowed him to gain his quality of life back.

INDICATIONS, SAFETY & WARNINGS

 
 

Indications, Safety & Warnings

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.

MAT-2001532 v2.0

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DO YOU WISH TO CONTINUE AND EXIT CARDIOVASCULAR.ABBOTT?

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