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Case Studies
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Case Studies
Atrial Fibrillation
Atrial Fibrillation/Left AFL
Using DIRECTSENSE™, physicians were able to terminate arrhythmia in a patient who’d presented in atrial fibrillation with durable PVI and fractionated EGMs.
DeNovo Atrial Fibrillation
A DeNovo PVI was performed on a PAF patient by first creating a CS-paced map with the INTELLAMAP ORION™ Mapping Catheter with the RHYTHMIA HDx™ Mapping System to assess Left Atrium voltage.
The INTELLANAV MIFI™ OI Catheter with DIRECTSENSE™ Technology was used for ablation with AUTOTAG coloring parameters set to Light Pink <14 Ω, Pink ≥14 Ω, Red ≥17Ω. During PVI, areas of fractionation were highlighted near the RSPV and LIPV using the LUMIPOINT™ Software Module’s complex activation tool.
Fractionated areas were ablated and a floor line was used to anchor them to the LPV and RPV and avoid future LAFL. Validation mapping confirmed PVI and floor line block. The total procedure time was 1:26.
“Local impedance is a very sensitive marker of field response. We notice variability changes when in contact with moving tissue versus more steady. [Local Impedance is a] nice way to tell different tissue properties.”
Video courtesy of Dr. Jose Cuellar-Silva (HCA Houston Healthcare Clear Lake| Webster, Texas)
Redo PVI Gap Highlight
In a patient with recurrence of atrial arrhythmia, LUMIPOINT™ revealed a well localized area of fractionated signals that represented a gap of conduction.
Paroxysmal Atrial Fibrillation
This patient with Paroxysmal Atrial Fibrillation had a second potential in the posterior wall (epicardial connection from CS). The signal was mapped to the roof and ablated. Signals from INTELLANAV MIFI™ OI Catheter begin walking out and disappear.
Video courtesy of Dr. Jose Cuellar-Silva (HCA Houston Healthcare Clear Lake | Webster, Texas)
Low Fluoro in AF, CTI Flutter and AT
This case video shows a RHYTHMIA HDxTM low fluoro procedure including a PVI, CTI Flutter and Atrial Tachycardia. Case time was 2.5 hours, with positive outcome and efficiency.
Video courtesy of Dr. Jose Cuellar-Silva (HCA Houston Healthcare Clear Lake | Webster, Texas)
Atrial Tachycardia
Atrioventricular Reentrant Tachycardia
Physicians using RHYTHMIA HDx™ mapped the entire circuit during tachycardia and identified Mahaim potentials in a patient found to have Mahaim-mediated AVRT.
Alternating Tachycardias with 1-Burn Terminations
A patient with a complex cardiac history presented with recurrent atrial flutter and atrial tachycardia. Dr. Sunil Sinha sequentially mapped and terminated alternating tachycardias with RHYTHMIA HDx™ in less than 36 minutes. Using LUMIPOINT™ and DIRECTSENSE™, both tachycardias were terminated with a single RF lesion each.
Video courtesy of Dr. Sunil Sinha (Johns Hopkins Heart and Vascular Institute|Baltimore, Maryland)
Focal AT on CTI
A focal atrial tachycardia was localized to the CTI. RHYTHMIA HDx™ and LUMIPOINT™ were used to differentiate between typical atrial flutter and focal AT on the isthmus and to target ablation. The tachycardia was fully terminated within a few seconds of RF delivery.
Video courtesy of Dr. Jose Cuellar-Silva (HCA Houston Healthcare Clear Lake |Webster, Texas)
Macroreentrant Circuit
A 66-year-old male, with previous PVI and CTI, presented in tachycardia. When the INTELLAMAP ORION™ Mapping Catheter was close to the LAA/LSPV ridge, the tachycardia terminated. The tachycardia was reinduced and the LA map was completed. Long, fractionated EGMs covering a majority of the cycle length were found at the ridge anterior to the LSPV. LUMIPOINT™ Software Module’s SKYLINE™ tool confirmed a macroreentrant circuit at the ridge, corresponding with the fractionated EGMs. After approximately 1.5 seconds of ablation, the tachycardia was terminated.
Video courtesy of Dr. Bruce Hook (Lahey Hospital & Medical Center | Burlington, Massachusetts)
Atrial Flutter
Mitral Annular-Dependent AFL
With RHYTHMIA HDx™, physicians collected low-voltage signals and identified the mitral annular-dependent driving circuit in a patient with atrial flutter.
LAFL Originating from RSPV
Following typical left atrial flutter ablation, an atypical flutter was mapped in the LA using INTELLAMAP ORION™. The RHYTHMIA HDx™ Mapping System identified and annotated low-voltage signals in the RSPV and mapped the entire cycle length. The first lesion terminated AFL in 5 seconds and subsequent lesions reisolated.
Video courtesy of Dr. Patrick Whalen (Wake Forest Baptist Health|Winston-Salem, North Carolina)
Left Atrial Flutter Case
In a patient receiving ablation for left atrial flutter, cardiac mapping with RHYTHMIA HDx showed a potential target near the initial focal breakout.
Atypical Right Atrial Flutter: Critical Isthmus Identification
In this patient case, physicians using RHYTHMIA HDx mapping and LUMIPOINT™ identified the circuit’s critical isthmus, enabling termination of AFL.
Roof-Dependent LAFL
Dr. Cuellar-Silva identified a roof-dependent left atrial flutter enabled by a gap in a previous posterior wall isolation. Voltage on the posterior wall was <0.02mV. LUMIPOINT™ rapidly highlighted the best target for ablation. LAFL was terminated within 3 seconds of RF delivery.
Video courtesy of Dr. Jose Cuellar-Silva (HCA Houston Healthcare Clear Lake |Webster, Texas)
Biatrial Flutter
A complex left atrial flutter mapped appears to use the RA to jump over previous anterior line and complete the circuit. LUMIPOINT™ helped determine a precise location for an efficient single-burn termination.
Video courtesy of Dr. Jose Cuellar-Silva (HCA Houston Healthcare Clear Lake |Webster, Texas)
Ventricular Tachycardia
Ventricular Tachycardia (PVC)
A patient presented experiencing a PVC every ~6th beat. Mapping the RV with the INTELLAMAP ORION™ Mapping Catheter, the RHYTHMIA HDx™ Mapping System and using the LUMIPOINT™ Software Module’s SKYLINE™ tool assisted with rapid identification of the true earliest activation at the basal mid-septal region.
At the site of earliest activation, DIRECTSENSE™ Technology was used to monitor stability and the micro-fidelity electrodes on the INTELLANAV MIFI™ OI Catheter allowed visualization of the fractionated signals during a PVC.
DIRECTSENSE Technology was used to guide ablation with AUTOTAG color parameters set to Light Pink <15 Ω, Pink ≥ 15 Ω, Red ≥ 20 Ω. The PVCs were terminated following ablation of the fractionated signals.
Image courtesy of Dr. Jason Chinitz (Southside Hospital | Bay Shore, New York)
VT Late Potential Identification
In this procedure, a patient with ventricular tachycardia underwent cardiac mapping with RHYTHMIA HDx. In 15 seconds, LUMIPOINT™ Software Module highlighted two areas with abnormal late potentials.
Ventricular Tachycardia
Patient with a history of ischemic cardiomyopathy was treated for recurrent ventricular tachycardia. Dr. Gallagher utilized the RHYTHMIA HDx™, INTELLAMAP ORION™, and LUMIPOINT™ software module to map the entire tachycardia circuit. Local Impedance guided ablation with INTELLANAV MIFI™ OI terminated VT with a linear ablation through the critical isthmus. AUTOTAG demonstrate red tags with >15ohm drops.
Image courtesy of Dr. Peter Gallagher (Nebraska Heart Institute, Lincoln, Nebraska)
