Three-dimensional electromagnetic catheter technology: Electroanatomical mapping of the right atrium and ablation of ectopic atrial tachycardia

Electroanatomical Mapping. Introduction: The difficult catheter orientation and navigation associated with conventional technology and mono-/multiplane fluoroscopy may complicate ablation procedures of atrial tachycardias. A new-three-dimensional catheter technology for electroanatomical mapping of the right atrium and ablation of ectopic atrial tachycardia is described. Methods and Results: A novel electromagnetic catheter-based mapping system was investigated for electroanatomical mapping of the entire right atrium in 12 patients. The system reconstructed three-dimensional maps from the multitude of endocardial sites that were sequentially mapped and color coded the individual activation times. The electrophysiologic information was superimposed on the geometry of the mapped area. The anatomical landmarks of the right atrium, i.e., the tricuspid annulus, mouth of the coronary sinus, ostia of the superior and inferior venae cavae, and right atrial appendage, could be depicted in all cases. The sinus node area and the preferential conduction along the crista terminalis could be delineated. In four patients with ectopic atrial tachycardia, the earliest endocardial activation could be identified with high spatial resolution as a "hot spot." After completion of the mapping procedure, the ablation catheter could be reliably renavigated to the site of origin, and ablation was successful with one or two impulses. In one patient with previous atrial septal repair, the activation map allowed the reconstruction of a long line of conduction block induced by the atriotomy. Conclusion: Three-dimensional electroanatomical mapping of the right atrium allowed detailed reconstruction of the chamber geometry and activation sequence. The sites of origin of ectopic atrial tachycardias could be identified precisely. The system allowed accurate renavigation to the site of earliest activation, thereby guiding successful ablation of the foci.