Co-Author(s):
Jose Martel, MD,MPH, FHRS - South Miami Hospital
Michael Bernard, MD, PhD - Ochsner Medical Center
Nicholas Olson, MD - Scripps Clinic and Prebys Cardiovascular Institute
Kevin Jackson, MD - Duke University Medical Center
Kevin Thomas, MD, FHRS - Duke University Medical Center
John Day, MD - Intermountain Medical Center
Sri Sundaram, MD, FHRS - South Denver Cardiology Associates
Toshimasa Okabe, MD - The Ohio State University Wexner Medical Center
Jonathan Piccini, MD, MHS, FACC, FAHA, FHRS - Duke University Medical Center
Caroline Tao, PhD - Abbott
Rajesh Venkataraman, MD - Houston Methodist The Woodlands
Arkansas Heart Hospital
7 Shackleford W Blvd, Little Rock, AR 72211
Introduction | Objectives: EnSiteā„¢ LiveView Dynamic Display utilizes the Advisorā„¢ HD Grid Mapping Catheter to provide beat-to-beat, dynamic display of regional mapping data. In addition to the unique features offered by the mapping catheter, the new software comes with various settings that allow the users to customize the mapping display to accommodate different case types. The optimal settings and workflows to incorporate the dynamic data into routine ablation procedures have not been explored.
Methods: Procedural characteristics including map appearance setting, reference electrode, workflow preference, and ablation strategy were prospectively collected from over 30 operators in 18 U.S. centers during the first three months of commercialization.
Results: A total of 119 cases were collected. The majority (91%) of the cases were indicated for mapping/ablation of atrial fibrillation (AF). The best duplicate algorithm was utilized in all cases with LiveView. AutoColor was used in 108 cases (91%), and the CS catheter was selected as the reference electrode in 99 cases (83%). Of note, 25 cases (21%) also reported the use of the HD Grid Mapping Catheter as the reference electrode. This was mostly observed in de novo ablation cases where LiveView was used after traditional full-chamber maps. Common map appearance settings for interior and exterior projection, and interpolation was 5, 7, and 7 respectively. Voltage cutoff of 0.1 mV, range from 0.05 to 1.5 mV, was most frequently observed (n=53, 45%) in this dataset for delineating scar. The use of dynamic display helped to identify areas that were under ablated in 88 cases (74%). Out of 119 cases, 68% of the cases indicated that using LiveView did decrease the amount of mapping required to confirm ablation targets and that the desired endpoint had been achieved.
Conclusions: Initial procedure data suggests minimal workflow changes are required to incorporate the use of dynamic data in AF procedures. Adaptation of LiveView can help improve procedure efficiency and efficacy by reducing the need for full chamber maps and identifying areas that were under ablated, and confirming ablation endpoints. Further control study examining procedure efficiency and efficacy associated with dynamic mapping in AF may be warranted.