A novel 3 D anatomic mapping approach using multipoint high-density voltage gradient mapping to quickly localize and terminate typical atrial flutter

Purpose The purposes of the study were to evaluate and characterize the cavotricuspid isthmus using multipoint high density voltage gradient mapping (HD-VGM) to see if this would improve on current ablation techniques compared to standard cavotricuspid isthmus ablation techniques. Methods Group 1, 25 patients who underwent ablation using standard methods of 3D mapping and ablation, was compared to group 2, 33 patients undergoing ablation using HD-VGM and ablation. Using this method, we are able to identify the maximum voltage areas within isthmus and target it for ablation. Total procedure times, ablation times and number of lesions, distance ablated, and fluoroscopy times were compared. Results Fifty-eight patients were included in this study. Compared to group 1, in group 2, HD-VGM decreased the total ablation time 18.2 ± 9.2 vs 8.3 ± 4.0 min (p < 0.0001), total ablation lesions 22.7 ± 18.8 vs 5.5 ± 4.2 (p < 0.0001), and the length of the ablation lesions was significantly shorter 47.0 mm ± 13 mm vs 32.6 mm ± 10.0 mm (p < 0.0001). While the average length of the CTI was similar, 47.0 mm ± 13 mm vs 46.1 mm ± 10.0 mm (p 0.87), in group 2, only 71% of the isthmus was ablated. Conclusion Multipoint high density voltage gradient mapping can help identify maximum voltage areas within the isthmus and when ablated can create bidirectional block with decreased ablation times and length of the lesion.