Abstract 17493: Simultaneous High-Density Contact Mapping plus Ablation of the Left Atrium for the Treatment of Atrial Fibrillation: a Novel Multi-Electrode Catheter System
Introduction: Current catheter technology for treatment of atrial fibrillation (AF) is limited by several factors, e.g. instability of the ablation electrode, missing options for simultaneous high-density mapping, or pulmonary vein isolation (PVI) only.
Hypothesis: A novel single-catheter multi-electrode system was developed for “global” treatment of AF, i.e. simultaneous high-density contact mapping (e.g. voltage mapping, rotor mapping) plus radiofrequency (RF) ablation (e.g. PVI, substrate modification).
Methods: The system consists of an array with 20 ribs containing up to 275 gold electrodes, which can be expanded within the body of the left atrium (LA) to a spherical, partially compliant device that contacts the atrial wall in a stable position. RF energy can be applied simultaneously at multiple electrodes as required for the individually tailored ablation of target tissue. The tracing of the ablation sites and subsequent ablation are done remotely in the control room. RF power output is determined by the system based on electrode contact. The temperature sensors are located 25μm behind each electrode. After extensive in-vitro testing, the catheter was deployed in-vivo in 5 canines for mapping and ablation.
Results: In in-vitro studies, the mean lesion depth measured 3.2±0.4, 3.7±0.4, 4.1±0.4, 4.8±0.3, and 5.1±0.3mm, respectively, depending on the temperature set point of 53, 55, 57, 59, and 61°C. In in-vivo studies, ablation lesion creation parameters ranged in temperature from 52-59 °C with application times of 60-180 seconds. Successful isolation was achieved in all 5 animals. Continuous “wave mapping” allowed for on-line observation of LA activation spread during ablation and for on-line confirmation of PVI or isolation of other targets (e.g. “box” isolation). Contiguity of lesion lines and lesion transmurality was confirmed by histology.
Conclusions: This multielectrode array is a completely new catheter concept permitting simultaneous high-density contact mapping of the entire LA plus RF ablation with a single device. Chronically, the lesions were shown to be contiguous, transmural and durable. The first in-human use is planned in a clinical study for Q4 of 2014.
Author Disclosures: H. Kottkamp: Consultant/Advisory Board; Modest; Kardium, BiosenseWebster. D. Reinders: None. S. Moisa: None. A. Sardari: None. D. Weinkam: None. J. Brewster: None. K. Chaplin: None.
- © 2014 by American Heart Association, Inc.