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Objective For fenestrated endovascular aneurysm repair (FEVAR), the implementation of the VesselNavigator (Philips Healthcare, Best, The Netherlands) to provide a 3-dimensional vessel roadmap has been shown to reduce patient radiation exposure. Unfortunately, FEVAR radiation doses remain substantial despite utilization of this technology. Traditionally, registration of the live fluoroscopy with the pre-operative CTA is performed via the acquisition of a low-dose cone-beam CT scan. However, this registration can also be accomplished with the acquisition of 2D X-rays using the c-arm in 2 different projection angles. We hypothesized that the 2D image acquisition for vessel roadmap development would result in a significant reduction in patient radiation dose in comparison to the 3D CT registration without compromising image quality or increasing procedural length. Methods This single-center, retrospective study included FEVARs performed from January 2015 to May 2019. For patient data, the cumulative reference air kerma (RAK) was presented as geometric mean and standard deviation. A general linear model with log-normal distribution was used to test the difference in patient RAK between 2D X-ray and 3D CT VesselNavigator registration after adjusting for BMI and the number of vessel fenestrations (1 to 2 vs. 3 to 4). Fluoroscopy time was recorded and used as a surrogate for case complexity. All analyses were done in SAS 9.4 (SAS Institute, Inc., Cary, North Carolina). Results One hundred and sixty four FEVARs were performed on a Philips Allura Xper FD 20 fluoroscopy system equipped with clarity technology. The VesselNavigator registration was completed using 3D CT mapping in 99 cases and 2D X-rays in 65 procedures. On average, utilization of 2D mapping versus 3D mapping for the VesselNavigator resulted in a 20.4% reduction in patient RAK after controlling for BMI and number of vessel fenestrations, P = 0.0135. There was no significant difference in fluoroscopy time between the 2 study groups (P= 0.81) suggesting that image quality was not compromised by the use of 2D mapping leading to the need for additional fluoroscopy. Conclusion Acquisition of 2D films rather than a 3D CT scan for VesselNavigator registration allows for a significant reduction in patient radiation dose during FEVAR without increasing the case complexity or compromising image quality.

Background Over the last 20 years various techniques have been developed striving for safer and more durable pulmonary vein isolation (PVI). The three most commonly used tools are pulmonary vein ablation catheter (PVAC) and cryoballoon (‘single-shot’ techniques), and point-by-point (PBP) radiofrequency ablation using 3D electroanatomical mapping (EAM). Objective Evaluate the safety and efficacy of the different techniques in an unselected population undergoing de-novo ablation for persistent or paroxysmal atrial fibrillation (AF) at Royal Papworth Hospital (RPH). Method Retrospective, single-centre study of consecutive AF ablations at RPH between March 2017 and April 2018. Demographic, procedural and outcome data were analysed. Results Over the study period 329 first-time PVI procedures were performed. 37.4% were performed using PBP, 39.8% using cryoballoon and 22.8% using PVAC. There was no significant difference in age or sex between different ablation technique groups. 238 procedures were performed for paroxysmal AF and 91 for persistent AF. A higher proportion of the persistent cases were performed using point-by-point techniques compared to paroxysmal cases (58.2% vs 29.0%, p, Highlights • The performance of PVAC, cryoballoon and point-by-point ablation in AF ablation has never been compared head-to-head-to-head. • Analysis of 329 PVI procedures showed no difference in symptomatic AF recurrence or safety outcomes between techniques. • Point-by-point procedures were longer.

Background: Catheter ablation can be curative in patients with drug-refractory tachyarrhythmias. 3D electro anatomical mapping (EAM) is an established tool facilitating catheter ablation. This system is particularly valuable for mapping complex arrhythmias, which provide excellent assistance to catheter navigation, reduces fluoroscopy exposure, and also allow for the accurate placement of catheters. The Rhythmia Mapping System (RMS, Boston Scientific) is a novel system that allows for ultra-fast, high-density 3D mapping. Aim of this Study: The aim of this study was to find out the result of a high-density 3D mapping for the ablation of complex Cardiac Arrhythmias and to share our experiences. Methods: A total number of 44 patients of different tachyarrhythmias were scheduled for catheter ablation by Rhythmia Mapping System in National Institute of Cardiovascular Diseases, Bangladesh from 3rd February’2018 to 18th July’2019. During and after, the procedure all the cases were evaluated for different procedure parameters, acute success and in-hospital success. Results: Among the patients (28/44 male) 13 (25.55%) cases were atrial fibrillation, 6 (16.64%) cases were atrial flutter, 6 (16.64%) cases were atrial tachycardia, 2 (4.55%) cases were ventricular tachycardia, 11 (25%) cases were PVC and 6 (16.64%) cases were accessory pathway. The mean age was 38±4.5 years. In 25 (56.82%) of tachyarrhythmia patients, the mechanism was macro reentry/micro reentry, while in 19 (43.18%) cases the mechanism was increased automaticity. In all cases, the tachycardias were adequately mapped & proper identification of focus was done during the index procedure with the ultra-high density 3-D Rhythmia Mapping System (RMS). These all were successfully terminated by radiofrequency ablation, except one, which was one of the two cases of Ventricular tachycardia. With this system our study samples had a success rate of 98% with arrhythmia elimination. In patients of atrial fibrillation, all 4 pulmonary veins isolation were done. The mean mapping time was 28.6 ± 17 minutes, and the mean radiofrequency ablation time to arrhythmia termination was 3.2± 2.6 minutes. During our study only two out of 44 patients developed complications. One of the patients with atrial fibrillation developed cardiac tamponade and the other patient with PVC originating from Aortic cusp developed ischemic stroke. Fortunately, they were both managed accordingly. During hospital discharge, all the patients were free of tachyarrhythmia and were in sinus rhythm. Conclusions: This new automated ultrahigh-resolution mapping system allows accurate diagnosis of tachyarrhythmia circuits. Ablation of the focus resulted in high acute success. Bangladesh Heart Journal 2021; 36(2): 98-104

BACKGROUND Intracardiac electrogram data remain one of the primary diagnostic inputs guiding complex ablation procedures. However, the technology to collect, process, and display intracardiac signals has known shortcomings and has not advanced in several decades. OBJECTIVE The purpose of this study was to evaluate a new signal processing platform, the PURE EP™ system (PURE), in a multi-center, prospective study. METHODS Intracardiac signal data of clinical interest were collected from 51 patients undergoing ablation procedures with PURE, the signal recording system, and the 3D mapping system at the same time stamps. The samples were randomized and subjected to blinded, controlled evaluation by three independent electrophysiologists to determine the overall quality and clinical utility of PURE signals when compared to conventional sources. Each reviewer assessed the same (92) signal sample sets and responded to (235) questions using a 10-point rating scale. If two or more reviewers rated the PURE signal higher than the control, it was deemed superior. RESULTS A total of 93% of question responses showed consensus amongst the blinded reviewers. Based on the ratings for each pair of signals, a cumulative total of 164 PURE signals out of 218 (75.2%) were statistically rated as Superior for this data set (p

We describe a case of pacemaker implant guided by intracardiac echocardiography and three-dimensional anatomical mapping in a pregnant patient, with no peri-procedural use of radiation.

Radiofrequency catheter ablation (RFCA) is the primary choice for treating patients with an accessory pathway and atrioventricular re-entrant tachycardia. However, using RFCA to treat a right-sided accessory pathway in a patient with Ebstein anomaly can be difficult owing to challenges in locating the electrophysiological atrioventricular groove. We report a case of atrioventricular re-entrant tachycardia in a patient with Ebstein anomaly and a right-sided accessory pathway that was successfully treated using RFCA and 3-dimensional (3D) high-density mapping. RFCA and 3D mapping may be useful in the management of such cases and may aid in improving prognoses of patients.

Background This is a rare and challenging case of Wolff–Parkinson–White syndrome due to a posteroseptal accessory pathway located in the coronary sinus diverticulum. It is often difficult to precisely locate this type of accessory pathway, and the ablation procedure could be associated with collateral damage to the neighbouring coronary arteries. Case Presentation The patient was a 49-year-old female with Wolff–Parkinson–White syndrome who was referred for catheter ablation. She had had a previous unsuccessful attempt at ablation and had remained symptomatic despite drug therapy. The pre-procedural cardiac computed tomography scan revealed the presence of a diverticulum in the proximal coronary sinus. Using an advanced three-dimensional cardiac mapping system, the electroanatomic map of the diverticulum was created. The accessory pathway potential was identified within the diverticulum preceding the ventricular insertion. The accessory pathway was then successfully ablated using radiofrequency energy. Conclusion We have demonstrated that the advanced three-dimensional cardiac mapping system plays a very important role in guiding clinicians in order to precisely locate and safely ablate this type of challenging accessory pathway.

Aims This report describes the findings of the 2018 Italian Catheter Ablation Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC). Methods The Italian Catheter Ablation Registry systematically collects data on the ablation procedures performed in Italy. Data collection was retrospective. A standardized questionnaire was completed by participating centres. Results We collected data on 15 714 catheter ablation procedures performed in Italy during 2018 in 94 electrophysiology centres. In most centres (75/94, 80%), a single electrophysiology laboratory was available, and a hybrid electrophysiology laboratory was available in 15% (14/94) of centres. In most (93%) centres, at least two electrophysiologists were involved in the catheter ablation procedures. In only 13 out of 94 (14%) electrophysiology laboratories, an anaesthesiologist assists every electrophysiology procedure; in most cases (74/94, 79%), an on-demand anaesthesiology service was available. On-site cardiothoracic surgery was reported in 43 out of 94 (46%) centres.Nonfluoroscopic navigation systems were available in most centres (88/94, 93%). Intracardiac echocardiography was used in 59 out of 94 (63%) electrophysiology laboratories. Atrial fibrillation (31%) was the most frequently treated ablation target, followed by atrioventricular nodal re-entrant tachycardia (20%) and cavo-tricuspid isthmus (15%). In 61.7% of all procedures, a 3D mapping system was used. In about one-third of procedures, a near-zero approach was performed. Conclusion In most Italian electrophysiology centres, a single electrophysiology laboratory was available and at least two electrophysiologists were involved in the ablation procedures. An increasing number of procedures were performed by means of a nonfluoroscopic mapping system with a near-zero approach.

Background: Intracardiac echocardiography and 3D mapping systems allow catheter ablation for atrial fibrillation (AF) to be conducted without fluoroscopy; however, the safety and effectiveness of fluoroless AF ablation are not well defined. Methods: We examined consecutive radiofrequency AF catheter ablations at a large academic teaching hospital from November 2017 to July 2019. Outcomes for fluoroscopy-guided (N = 176) and fluoroless (N = 147) ablations were compared. Cases were designated as fluoroless at the outset of the procedure. Results: Mean age was 59.5 ± 10 years, 66.9% were male, 71.8% had paroxysmal AF, and the mean CHA2DS2-VASc score was 1.7 ± 1.4. There were no differences in patient baseline characteristics. In the fluoroless group, minimal fluoroscopy was used in 17 patients (median, 3 seconds; interquartile range, 1.2-4.8). Mean procedure time, fluoroscopy time, and radiation dose (± standard deviation) were greater in the fluoroscopy group compared with the fluoroless group (194 ± 56 vs 176 ± 46 minutes, P = 0.0021; 10.7 ± 6.6 vs 0.008 ± 0.03 minutes, P < 0.0001; 2759.2 ± 1911 vs 5.4 ± 24 μGy m2, P < 0.0001). In multivariable linear regression models, fluoroless AF ablation was independently associated with reduced procedure times (ß = −16.5 minutes, P = 0.01). Acute procedural success (95.5% vs 98.6%, P = 0.1), complication rates (4.5% vs 2.0%, P = 0.24), and 1-year AF recurrence rates (28.7% vs 27.1%, log-rank P = 0.69) were similar between fluoroscopy and fluoroless groups. Excluding the 17 patients receiving fluoroscopy in the fluoroless group did not impact our results (P = 0.013). After exclusion of redo cases, fluoroless AF ablation was no longer associated with reduced procedure times (ß = −11.4 minutes, P = 0.106). Conclusions: Fluoroless radiofrequency AF ablation had similar effectiveness and safety compared with conventional fluoroscopy-guided AF ablation. Résumé: Contexte: L'échocardiographie intracardiaque et les systèmes de cartographie 3D permettent l'ablation par cathéter de la fibrillation auriculaire (FA) sans fluoroscopie; l'innocuité et l'efficacité d'une telle approche ne sont toutefois pas bien connues. Méthodologie: Nous avons examiné les résultats d'ablations par cathéter de la FA par radiofréquences menées de façon consécutive dans un hôpital universitaire d’envergure entre novembre 2017 et juillet 2019. Les résultats des ablations par fluoroscopie (n = 176) et des ablations sans fluoroscopie (n = 147) ont été comparés. Les cas étaient désignés comme n'ayant pas utilisé la fluoroscopie à la fin de l'intervention, le cas échéant. Résultats: L'âge moyen était de 59,5 ± 10 ans, 66,9 % des patients étaient des hommes, 71,8 % étaient atteints de FA paroxystique, et le score CHA2DS2-VASc moyen était de 1,7 ± 1,4. Il n'y avait pas de différences entre les caractéristiques des patients au départ. Dans le groupe ayant subi une ablation sans fluoroscopie, une fluoroscopie minimale a été utilisée chez 17 patients (médiane : 3 secondes; intervalle interquartile : 1,2-4,8). La durée moyenne de l'intervention, la durée de la fluoroscopie, et la dose de rayonnements (± écart type) ont été plus élevées dans le groupe avec fluoroscopie que dans le groupe sans fluoroscopie (194 ± 56 vs 176 ± 46 minutes, p = 0,0021; 10,7 ± 6,6 vs 0,008 ± 0,03 minute, p < 0,0001; 2759,2 ± 1911 vs 5,4 ± 24 μGy m2, p < 0,0001). Dans des modèles de régression linéaire multivariables, l'ablation de la FA sans fluoroscopie a été associée de façon indépendante à des interventions de plus courte durée (ß = −16,5 minutes, p = 0,01). Le succès immédiat de l'intervention (95,5 % vs 98,6 %, p = 0,1), le taux de complications (4,5 % vs 2,0 %, p = 0,24), et le taux de récidive de la FA après 1 an (28,7 % vs 27,1 %, p (test du log-rank = 0,69) ont été comparables dans les groupes avec et sans fluoroscopie. L'exclusion des 17 patients chez qui la fluoroscopie avait été utilisée dans le groupe sans fluoroscopie n'a pas modifié ces résultats (p = 0,013). Après l'exclusion des cas où l'intervention était une reprise, l'ablation de la FA sans fluoroscopie n'était plus associée à une réduction des durées d'intervention (ß = −11,4 minutes, p = 0,106). Conclusions: L'ablation de la FA par radiofréquences sans fluoroscopie est associée à une efficacité et à une innocuité comparables à celles de l'ablation de la FA classique guidée par fluoroscopie.

Background Substrate analysis of the left atrium in patients undergoing atrial fibrillation ablation has limitations when performed by means of simple bipolar acquisition. Objective To evaluate the incidence of low‐voltage zones (LVZs) through maps constructed by means of various catheters: multipolar (MC), omnipolar (OC), and circular catheters (CMCs) with the 3D electro‐anatomical systems (3d‐S) CARTO3 and EnSite Precision. Methods To assess LVZs, we acquired maps by means of CMC and MC in the voltage range 0.05‐0.5 mV in 70 consecutive patients in sinus rhythm. In the case of OC only, we made an intra‐patient comparison of bipolar maps constructed by means of the along and across, and HD‐Wave configurations of the EnSite 3d‐S in the ranges of 0.05‐0.5 and 0.5‐1.0 mV. On the basis of this comparison, we chose the range that best identified LVZs as a set of different colors (SDC) compatible with patchy fibrosis (qualitative analysis). Subsequently, we detected the voltage values corresponding to purple and gray points, close to SDC, and the value inside corresponding to blue, green, and red colors, and we evaluated the color change in other voltage ranges. Finally, we performed a quantitative analysis of LVZs by applying the qualitative characteristics described above. Results On the basis of our settings, for OC, the optimal range identifying LVZs was 0.3‐0.6 mV. OC revealed smaller LVZs than MC (P, This project aims to evaluate the incidence of low voltages through maps constructed by means of various catheters: multipolar (MC), omnipolar (OC), and circular catheters (CMCs) with the 3D electro‐anatomical systems (3d‐S) using an optimized voltage range (0.3‐0.6 mV) to identify better LVZs.

Die Fortschritte der kardialen Bildgebung und bei den 3‑D-Mappingverfahren haben in der letzten Dekade zu einem signifikanten Erkenntnisgewinn hinsichtlich der Korrelation ventrikularer Extrasystolen (VES) mit anatomischen Strukturen gefuhrt. Bei allem technischen Fortschritt bleibt die Interpretation des 12-Kanal-EKGs Grundlage fur die klinische Praxis. So lasst sich mit fundiertem Grundwissen uber die kardiale Anatomie und Erregungsausbreitung – unter Berucksichtigung der Limitationen der Methode – die Herkunft ventrikularer Ektopien mit hinreichender Genauigkeit bestimmen. Zur groben Eingrenzung reichen bereits wenige Anhaltspunkte. Anhand des Lagetyps kann zwischen einem diaphragmalen Ursprung mit superiorer Achse und einem weiter superior gelegenen Ursprung mit einem nach inferior gerichteten Summationsvektor unterschieden werden. In den Brustwandableitungen kann mit hoher Wahrscheinlichkeit von einem linksventrikularen Ursprung einer Ektopie ausgegangen werden, wenn diese eine Rechtsschenkelblock-Morphologie oder positive Konkordanz zeigt. Eine Linksschenkelblock-Morphologie kann neben dem rechten Ventrikel als Ursprungsort auch das interventrikulare Septum miteinschliesen. Je spater die R/S-Transition der Brustwandableitungen erfolgt, desto weiter anterior ist der Ursprung der VES. Die sich kreuzenden Ausflusstrakte der Ventrikel erschweren eine Lokalisation von VES aus diesem Bereich. Hier gibt v. a. die Form und Hohe der R‑Zacke in V1–V3 einen Aufschluss uber den moglichen Ursprungsort. Unscharfen in der EKG-Lokalisation bestehen insbesondere bei semimobilen Strukturen wie den Papillarmuskeln und dem Moderatorband, mit variablem Verlauf innerhalb der Ventrikel. Auf Basis der so gewonnenen Informationen kann in der Folge eine fundierte Einschatzung uber die Prognose und den zu erwartenden Erfolg einer medikamentosen oder invasiven Therapie getroffen werden.

Tau protein neurofibrillary tangles are closely linked to neuronal/synaptic loss and cognitive decline in Alzheimer’s disease and related dementias. Our knowledge of the pattern of neurofibrillary tangle progression in the human brain, critical to the development of imaging biomarkers and interpretation of in vivo imaging studies in Alzheimer’s disease, is based on conventional two-dimensional histology studies that only sample the brain sparsely. To address this limitation, ex vivo MRI and dense serial histological imaging in 18 human medial temporal lobe specimens (age 75.3 ± 11.4 years, range 45 to 93) were used to construct three-dimensional quantitative maps of neurofibrillary tangle burden in the medial temporal lobe at individual and group levels. Group-level maps were obtained in the space of an in vivo brain template, and neurofibrillary tangles were measured in specific anatomical regions defined in this template. Three-dimensional maps of neurofibrillary tangle burden revealed significant variation along the anterior-posterior axis. While early neurofibrillary tangle pathology is thought to be confined to the transentorhinal region, we found similar levels of burden in this region and other medial temporal lobe subregions, including amygdala, temporopolar cortex, and subiculum/cornu ammonis 1 hippocampal subfields. Overall, the three-dimensional maps of neurofibrillary tangle burden presented here provide more complete information about the distribution of this neurodegenerative pathology in the region of the cortex where it first emerges in Alzheimer’s disease, and may help inform the field about the patterns of pathology spread, as well as support development and validation of neuroimaging biomarkers.

Atrial and ventricular arrhythmias significantly contribute to morbidity and mortality of patients with cardiac disease. Ablation of these arrhythmias has shown to improve clinical outcomes, yet targeted ablation strategies rely on proper mapping capabilities. In the present study, we compare different modes of high-resolution mapping in clinically relevant arrhythmias using HD grid.Using the Advisor™ HD Grid Mapping Catheter in either the standard, the wave (bipolar along spline and bipolar orthogonal) or the wave diagonal setting, low-voltage areas were determined. Low-voltage was defined as local electrograms with an amplitude0.5 mV (bipolar; atria/ventricle) or4 mV (unipolar; ventricle). Ultra high-density mapping in 47 patients with ventricular tachycardia, ventricular premature beats, atrial fibrillation and atrial tachycardia provided reliable information for the understanding of the arrhythmia mechanism resulting in safe ablation procedures. Regions of low voltage were significantly decreased by 14 ± 2% and 31 ± 3% with wave and wave diagonal settings as compared to standard settings, respectively.Substrate mapping and risk stratification relies on proper low voltage discrimination. Even though the Advisor™ HD Grid Mapping Catheter was safely used in all cases, the extent of low voltage areas was mapping-mode dependent.

Die Sorge vor Strahlenexposition beschaftigt viele junge Frauen in der Kardiologie und ist mit fur die niedrige Anzahl invasiv tatiger Kolleginnen verantwortlich. Der Frauenanteil in der Elektrophysiologie ist besonders niedrig. Dabei erlauben moderne 3‑D-Mapping-Techniken heutzutage strahlenarme und sogar strahlenfreie Katheterablationen. Die Perspektive „zero fluoro“ dient nicht nur der Patientensicherheit, sondern hat auch das Potenzial, die Elektrophysiologie weiblicher zu machen.

Introduction. Fluoroscopy integration with three dimensional (3D) electroanatomical mapping system may allow dose reduction while invasive electrophysiological procedures. In this retrospective study we present real-population experience with integrated model. Material and methods. Ninety-six patients with paroxysmal atrial fibrillation (AF) after radiofrequency pulmonary vein isolation have been analyzed. In 48 patients, 3D mapping system integrated with fluoroscopy (Carto 3 UniVu) has been used. Clinical and peri-procedural data, inclusive, fluoroscopy time and dose, in-hospital complications and efficacy rate at 6 months have been compared. Results. Patients treated with classic 3D mapping system were significantly older (p = 0.036). Both fluoroscopy mean time (11.6 ± 4.3 vs. 6.7 ± 2.9 minutes, p Conclusions. Utilization of novel 3D mapping systems with classic fluoroscopy integration supports the radiation time and the dose reduction during AF ablation procedure, without any adverse impact on the total procedure time, complication or success rate. This real-life population results corresponds with previously presented prospective studies.

PURPOSE: In this study, we evaluated the feasibility, efficacy, and safety of radiofrequency ablation of paroxysmal atrial fibrillation (AF) with the use of an ablation catheter only (non-CMC group) by retrospectively comparing its procedural success and recurrence rates at 1 year to ablation performed with the help of a circular mapping catheter (CMC group). METHODS: We compared the success and recurrence rates between 226 patients and 251 patients who underwent index ablation with and without the use of CMC, respectively. RESULTS: Freedom from recurrence was defined as a 1-year absence of AF/atrial tachycardia (AT) episodes > 30 s, beyond the 3-month blanking period. There was no significant difference between the number of pulmonary vein isolations, recurrence rate of AF/AT, and the use of antiarrhythmic drugs after 1 year of ablation. The procedure and fluoroscopy times were lower in the non-CMC group compared with the CMC group (106 ± 33 vs. 125 ± 32 min, p < 0.0001; 2.2 ± 1.9 vs. 2.7 ± 2.3 min, p = 0.0002, respectively). CONCLUSIONS: Pulmonary vein isolation without the use of a CMC is feasible; moreover, the material costs, procedure time, and radiation exposure were reduced compared with the CMC group. Freedom of recurrence was similar between groups. Optimized use of 3D electro-anatomical mapping systems could reduce the radiation exposure for both the patient and physician.

Mapping and ablation of atriofascicular fibers can be highly challenging due to the complex and dynamic anatomy of the tricuspid valve annulus. This case highlights the utility of a multi-electrode catheter three-dimensional mapping approach to localize the Mahaim pathway along the tricuspid annulus in order to guide catheter ablation.

Ablation is an established treatment for ectopy originating from the left ventricle (LV). We report on a case of noninvasive 3-dimensional mapping locating the origin precisely in the epicardial LV summit area. However, after failed attempts from LV and epicardially, ablation via the left atrial appendage was finally successful. (Level of Difficulty: Advanced.), Graphical abstract, Ablation is an established treatment for ectopy originating from the left ventricle (LV). We report on a case of noninvasive 3-dimensional mapping…

Complex atrial tachycardias (ATs) after catheter ablation or a MAZE procedure is sometimes difficult to determine the circuits of the tachycardia. A high-density, grid-shapes mapping catheter has been launched, which can be useful for detecting the detail circuits of tachycardias on three-dimensional mapping systems. The signal quality is also important for performing electrophysiological studies (EPSs), such as entrainment mapping, to identify the circuit. This unique mapping catheter has 1 mm electrodes on 2.5 Fr shafts, which improve the signal quality. The high-quality intracardiac electrograms facilitate differentiating small critical potentials, which allows us to perform detailed entrainment mapping in targeted narrow areas. Here, we describe a patient with a perimetral AT with epi-endocardium breakthrough after a MAZE surgery and catheter ablation, which was treated successfully along with detailed entrainment mapping using the HD Grid. This catheter with high-quality signals could be a significant diagnostic tool for a classic EPS as well as for the construction of 3D mapping.

AimsTibial plateau fractures (TPFs) are complex injuries around the knee caused by high- or low-energy trauma. In the present study, we aimed to define the distribution and frequency of TPF lines using a 3D mapping technique and analyze the rationalization of divisions employed by frequently used classifications.MethodsIn total, 759 adult patients with 766 affected knees were retrospectively reviewed. The TPF fragments on CT were multiplanar reconstructed, and virtually reduced to match a 3D model of the proximal tibia. 3D heat mapping was subsequently created by graphically superimposing all fracture lines onto a tibia template.ResultsThe cohort included 405 (53.4%) cases with left knee injuries, 347 (45.7%) cases with right knee injuries, and seven (0.9%) cases with bilateral injuries. On mapping, the hot zones of the fracture lines were mainly concentrated around the anterior cruciate ligament insertion, posterior cruciate ligament insertion, and the inner part of the lateral condyle that extended to the junctional zone between Gerdy’s tubercle and the tibial tubercle. Moreover, the cold zones were scattered in the posteromedial fragment, superior tibiofibular syndesmosis, Gerdy’s tubercle, and tibial tubercle. TPFs with different Orthopaedic Trauma Association/AO Foundation (OTA/AO) subtypes showed peculiar characteristics.ConclusionTPFs occurred more frequently in the lateral and intermedial column than in the medial column. Fracture lines of tibial plateau occur frequently in the transition zone with marked changes in cortical thickness. According to 3D mapping, the four-column and nine-segment classification had a high degree of matching as compared to the frequently used classifications. Cite this article: Bone Joint Res 2020;9(6):258–267.

Introduction Negative component abolition of the unipolar signal (unipolar signal modification [USM]) reflects the lesion transmurality. The purpose of this study was to compare the procedural safety and outcome between high‐power and conventional‐power atrial radiofrequency applications during a pulmonary vein isolation (PVI) using USM as a local endpoint. Methods and Results High‐power (50 W) and conventional‐power (25‐40 W) applications were compared among 120 consecutive patients with paroxysmal atrial fibrillation who underwent a USM‐guided PVI. The first 60 patients were treated with conventional‐power (CP) group and last 60 with high‐power (HP) group. The atrial radiofrequency applications lasted for 5 to 10 seconds (CP group) or 3 to 5 seconds (HP group) after the USM. All procedures were performed using 3D mapping systems with image integration and esophageal temperature monitoring. The baseline characteristics were similar between the two groups. The HP group had fewer acute PV reconnections (62% vs 78%; P = .046) and a reduced procedure time (119.3 ± 28.1 vs 140.1 ± 51.2 minutes; P = .04). Freedom from recurrence after a single ablation procedure without any antiarrhythmic drugs was higher in the HP group than CP group (88.3% vs 73.3% at 12‐months after the procedure, log‐rank; P = .0423). There were no major complications that required any intervention. Conclusions The high‐power PVI guided by USM decreased the procedural time and may improve the procedural outcomes without compromising the safety.

International audience; We produced new multi-temporal Digital Elevation Models (DEMs) of the April 2007 summit collapse at Piton de la Fournaise from previously unused aerial photographs. This dataset reveals the precise temporal evolution of the collapsed volume and caldera morphological changes during the event. It provides a unique opportunity to study caldera formation, one of the most hazardous natural phenomena, for which relatively little scientific and quantified information is available. During this rare example of observed caldera formation, the summit started to collapse four days after the onset of a high-volume eruption at an unusually low elevation (at 20:48 UTC on April 5 th). Our new data show that during the first 30 hours, collapse was relatively fast (840 m 3 s −1 average), and continued for at least the following 12 days, at a slower rate (46 m 3 s −1 average), which had not previously been reported. On April 19 th , the collapse reached 96 % of its final volume, while the remaining 4 % was probably attained by May 1 st (end of lava emission at the vent). New infrared 3D mapping of the caldera floor made a year after the event demonstrates that post-collapse hydrothermal activity in the caldera is closely associated with the main ring faults active during the collapse, which are now preferential paths for fluids to reach the surface.

Recently, 4-dimensional computed tomography (4DCT) has become available for the preoperative planning of transcatheter aortic valve intervention.1 The 4DCT is reconstructed at 10% increments over the cardiac cycle, so that the 4DCT can evaluate not only the displacement of perivalvular structures but also the displacement of the myocardium.2 Most premature ventricular contractions (PVCs) arise from normal hearts. Further, it has been reported that PVCs arise from low-voltage areas and/or scar areas observed on voltage maps during electrophysiological studies, despite a structurally normal heart.3,4 Further, it has also been reported that a heterogeneous distribution of collagen within an infarct and the subendocardial layer is consistent with voltage mapping.5 From the above, we considered that an impaired myocardium would be displayed as having low dynamics on the 4DCT, whereas it would be displayed as a low-voltage or scar region on the voltage map. We herein describe our case, in which catheter ablation of PVCs was successfully performed, and a low-displacement area on the 4DCT corresponded to a low-voltage region on the voltage map.

Background Catheter ablation of accessory pathways (AP) with bidirectional conduction may be challenging due to issues related to anatomical course or location. Objective We describe an alternative electro-anatomical mapping technique which aims at depicting the entire anatomic course of the AP from the atrial toward the ventricular insertion in order to guide catheter ablation. Methods Twenty consecutive patients with confirmed bidirectional AP conduction and at least one previous ablation procedure or para-Hisian location were included. 3-D electro-anatomical mapping was used to depict the merged 10-ms isochrone area of maximum early activation of both the ventricular and atrial signals during sinus rhythm and ventricular pacing/orthodromic tachycardia, respectively. Catheter ablation was performed within the depicted earliest isochrone area. Results Acute bidirectional AP conduction block was achieved in all patients 4.2 +/- 1.7 s after the first radiofrequency energy pulse was delivered, without reconnection during a 30 +/- 10 min post-ablation observation time. No procedural complications were seen. After a mean follow-up period of 9 +/- 7 months (range 3 to 16), no recurrences were documented. Conclusion This merged two-way mapping technique is a safe, efficient, and effective technique for ablation of APs with bidirectional conduction.

Catheter ablation procedures involve fluoroscopy and can result in significant radiation exposure to the patient and staff. From the early 1980s to 2006, there was a 600% increase in the average medical radiation dose per person per year in the USA. Toward the end of this time frame, three-dimensional (3D) mapping systems, which use magnetic or electrical fields to track catheter location and movement, became clinically available. This has allowed reduction in fluoroscopy use. The goal of this manuscript is to review the current state of zero fluoroscopy ablations. In the early 2000s, the first report of a 3D mapping system, used to replace fluoroscopy, emerged. By 2015, centers were routinely performing fluoroless ablations. Today, most centers use these systems to decrease radiation exposure. Multi-center registries now exist to quantify the changes in patient care. Increased radiation exposure is associated with increased long-term risk of cancer. Today’s 3D mapping systems allow most ablation procedures to be performed without the use of fluoroscopy. With further refinements in the available tools, coupled with increasing operator experience, radiation exposure will be eliminated for all routine ablation procedures.

Background: The management of intra-articular calcaneal fractures (ICFs) still faces a challenge. Available research about the anatomic patterns of ICFs is lacking. We aimed to define the pattern of ICFs by a three-dimensional (3D) mapping and determine whether there are consistent fracture patterns and comminution zones. Methods: 67 patients of ICFs with available computed tomographic (CT) scans were identified. The calcaneal fractures fragments on CT were multiplanar reconstructed and virtually reduced. 3D heat mapping was subsequently created by graphically superimposing all fracture lines onto a standard calcaneal template. Mapping of fracture lines and comminution zones in both the axial and sagittal planes were performed. Results: The cohort included 26 (38.8%) left calcaneal fractures, 27 (40.30%) right calcaneal fractures, and 14 (20.9%) cases with bilateral fractures. Comminuted fractures accounted for 92.5% of all fractures. Sagittal 3D mapping demonstrated that fracture lines were concentrated in the critical angle of Gissane and extended posteriorly to the rear of the tuberosity of the lateral wall and the anterior of the medial process of the calcaneus tuberosity but with more significant variation in the medial wall. The mean angle of fracture lines concerning the long axis of the calcaneal (LAC) was 29.1°and 19.2° in the lateral wall and medial wall, respectively. Axial 3D mapping demonstrated that fracture lines were primarily concentrated in the area anterior to the posterior joint facet and extended along the posterior joint facet and calcaneus sulcus to the posteriorly of the tuberosity. The mean angle of fracture lines concerning the LAC was 11° in the axial wall. 3D mapping demonstrated that the comminution zones are closely related to the internal structure and fracture mechanism. Conclusion: The data presented have elucidated there are consistent characteristic fracture patterns and comminution zones for ICFs. This study provides visual guidelines to understand fracture morphology, which may assist with fracture classification, preoperative planning, fixation concepts development, and internal structure analysis.

Funding Acknowledgements Type of funding sources: None. Background Cardiac computed tomography (CCT) is an essential tool for an efficient ablation for atrial fibrillation. 3D mapping guided ablation could also deliver sufficient results in the setting of cryoballoon ablation (CBA) with additional advantages regarding total patient radiation exposure, fluoroscopy and procedural time. Purpose To compare the 3D mapping with the Achieve® catheter versus the CCT on the procedural characteristics and acute outcome during CBA. Methods Consecutive patients who underwent CBA with the second-generation cryoballoon (CB) were retrospectively enrolled from a single centre registry. Baseline and procedural characteristics of patients with pre-procedural CCT (CT-Group) were compared to those with peri-procedural 3D mapping (Ensite PrecisionTM ) with the 1st generation Achieve® catheter (3D-Group). Results A total of 696 patients were enrolled, 327 (47%) in the CT-Group and 369 (53%) in the 3D-Group. Baseline characteristics were comparable between the two groups. Similar pulmonary vein (PV) anatomical variations were identified in both groups and all PVs were acutely isolated. The mean CB temperature (T) at 60s, the nadir T, the time to PV isolation, the T of isolation and the mean thaw time did not differ significantly. However, the total procedural and fluoroscopy time were significantly shorter as well as the dose area product was significantly less in the 3D-Group. Conclusion 3D mapping guided CBA using the Achieve® catheter is associated with significantly shorter fluoroscopy and procedural time and less patient radiation exposure. The anatomical acquisition of the PVs and the acute ablation outcome is non inferior to the CCT guided CBA. Procedural characteristics CT-Group n = 327 3D- Groupn = 369 p-value Paroxysmal AF 214 244 0.87 Total procedure time (min) 73.3 ± 23.1 65.1 ± 18.9 < 0.01 Fluoroscopy time (min) 14.9 ± 7.7 12.6 ± 7 0.02 DAP (Gy·cm2) 5924 ± 4991 4890 ± 3790 0.04 LCPV 37 41 1.00 RMPV 20 21 0.87 Mean T at 60s(oC) -41.9 ± 8.5 -40.6 ± 10.7 0.10 Mean nadir T(oC) -49.5 ± 6.4 -48.4 ± 7.8 0.18 Mean PVI time(s) 42.4 ± 26.3 38.1 ± 24.3 0.11 Mean PVI temperature(oC) -33.4 ± 11.6 -31.1 ± 22 0.16 Mean thaws time(s) 51.5 ± 20.5 51.8 ± 20.3 0.85

Funding Acknowledgements Type of funding sources: None. Introduction Catheter navigation and 3-dimensional (3D) cardiac mapping are critical for successful electrophysiological ablation procedures. A novel 3D mapping system received CE Mark in July 2020. The system offers two imaging modalities: magnetic-based (VoXel) and impedance-based (NavX). Real-time display of 3D location and catheter movements is achieved via a magnetic field frame and magnetic sensors with supplemental impedance data when operating in VoXel mode or primarily via an impedance field generated from surface electrodes in NavX mode. To address limitations in data collection commonly experienced during 3D mapping, a new respiratory compensation algorithm, patient movement detection module, and metal compensation algorithm have been developed to enable consistent data collection throughout the full respiratory cycle even in challenging cases and lab environments. Purpose To examine the clinical utility and procedural characteristics associated with the use of this novel 3D mapping system among participating centers. Methods Procedural data was collected in cases utilizing the newly cleared mapping system during the initial evaluation phase in Europe. Procedural characteristics recorded included indication for mapping and ablation, rhythm mapped, chambers mapped, and procedure time. Results Procedural data was collected from over 250 cases across 12 European centers. A total of 12 indications for mapping and ablation were represented including de novo and redo atrial fibrillation (paroxysmal, persistent, long-standing persistent), ventricular tachycardia (ischemic, non-ischemic) or premature ventricular contraction, and supraventricular arrhythmias (typical and atypical atrial flutter, atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia). Over 70% of the cases were performed in VoXel mode. Impedance mode was mostly used in SVT cases or when the case was intended to be completed with minimal fluoroscopy. The most commonly mapped rhythms were sinus rhythm during voltage mapping and atrial tachycardia. The majority of cases (over 65%) were completed under conscious sedation; general anesthesia was used in 20% of the cases (15% not reported). The respiratory compensation algorithm was utilized in over 90% of the cases. For cases in which pre-procedural computed tomography or magnetic resonance imaging were available, operators indicated that the model shape was accurate when compared to pre-procedural imaging in 96% of the cases performed in VoXel mode. Conclusions Initial European experience with this novel 3D mapping system included a wide variety of arrhythmias in the atria and ventricles. This new mapping system offered operators the flexibility to tailor to specific procedure needs with two imaging modalities which were both widely utilized.

Background Conduction channels have been demonstrated within the postinfarct scar and seem to be co-located with the isthmus of ventricular tachycardia (VT). Mapping the local scar potentials (SPs) that define the conduction channels is often hindered by large far-field electrograms generated by healthy myocardium. Objective The purpose of this study was to map conduction channel using ripple mapping to categorize SPs temporally and anatomically. We tested the hypothesis that ablation of early SPs would eliminate the latest SPs without direct ablation. Methods Ripple maps of postinfarct scar were collected using the PentaRay (Biosense Webster) during normal rhythm. Maps were reviewed in reverse, and clusters of SPs were color-coded on the geometry, by timing, into early, intermediate, late, and terminal. Ablation was delivered sequentially from clusters of early SPs, checking for loss of terminal SPs as the endpoint. Results The protocol was performed in 11 patients. Mean mapping time was 65 ± 23 minutes, and a mean 3050 ± 1839 points was collected. SP timing ranged from 98.1 ± 60.5 ms to 214.8 ± 89.8 ms post QRS peak. Earliest SPs were present at the border, occupying 16.4% of scar, whereas latest SPs occupied 4.8% at the opposing border or core. Analysis took 15 ± 10 minutes to locate channels and identify ablation targets. It was possible to eliminate latest SPs in all patients without direct ablation (mean ablation time 16.3 ± 11.1 minutes). No VT recurrence was recorded (mean follow-up 10.1 ± 7.4 months). Conclusion Conduction channels can be located using ripple mapping to analyze SPs. Ablation at channel entrances can eliminate the latest SPs and is associated with good medium-term results.

Congenitally corrected transposition of great arteries (CCTGA) is associated with increased risk for complete heart block. The morphologic right ventricle is at increased risk for pacing-induced cardiomyopathy and heart failure. In this report, we present a case of successful His bundle pacing (HBP) guided by 3-dimensional (3D) mapping in a patient with CGTGA.

Background: Electro-anatomic 3D mapping systems enable the fluoroscopy (FL) exposure to be reduced. In right-heart supraventricular tachycardia (SVT) procedures, FL could potentially be avoided. Our aim was to discuss some steps focusing on safety. Methods and results: The patient cohort comprised 70 consecutive SVT patients who underwent electrophysiologic (EP) catheterization. FL was routinely avoided in all cases (54.2% males, age 57.2 ± 13.3 years): 51 ablations and 19 EP study procedures. The Carto®3 (Biosense Webster) mapping system was used in 17/70 cases (24.3%), and the EnSite Precision™ (Abbott) system in the remaining 53/70 (75.7%). The mean procedure time was 94.1 ± 33.2 min; no FL was used. No major complications occurred. Acute procedural success was achieved in all 51 patients who underwent ablation. Over 3-month follow-up, arrhythmia recurred in 1 patient. There were no significant differences in procedural times between the two mapping systems, except for the time dedicated to the full geometry creation, which was longer for the EnSite Precision™ system: 10 min (8.5–15 IQR) vs 8 min (5–10 IQR) for the Carto® system (p

Ultra-high-density mapping allows very accurate characterization of circuits/mechanisms in atrial tachycardia (AT). Whether these advantages will translate into a better procedural or long-term clinical outcome is unknown. Sixty consecutive AT ablation procedures using ultra-high-density mapping (Rhythmia™, group 1) were retrospectively compared to 60 consecutive procedures using standard high-density mapping (Carto/NavX™, group 2) (total 209 AT, 79% left AT). A higher number of maps were performed in group 1 (4.8 ± 2.5 vs 3.2 ± 1.7, p = 0.0001) with similar acquisition duration (12 ± 5 vs 13 ± 6 min per map, p = ns), although with a greater number of activation points (10,543 ± 5854 vs 689 ± 1827 per map, p

Regular atrial tachycardia (AT) is one of the most important proarrhythmic complications that may occur following left atrial pulmonary vein isolation (PVI). These tachycardias that develop after atrial fibrillation ablation may lead to worse symptoms than those from the original arrhythmia existing prior to the index ablation procedure. Ablation of various types of supraventricular tachycardias without the use of fluoroscopy has been shown to be feasible in both children and adults using three-dimensional mapping systems. We describe the case of a 71-year-old woman who developed a focal AT after a successful PVI procedure. The initial ablation failed with one mapping system. Repeat electrophysiologic study despite antiarrhythmic medications revealed the same focal AT, which was successfully ablated with a different mapping system. Both ablations were performed without fluoroscopy.

Introduction Detailed three-dimensional (3D) mapping has been useful for effective radiofrequency catheter ablation. The Rhythmia system can create atrio-ventricular dual-chamber mapping, which reveals the atrial and ventricular potentials all at once in the same map. The aim of this study was to investigate the utility of mapping the atrium and ventricle simultaneously with a high-density 3D mapping system for the ablation of accessory pathways (AP). Methods From July 2015 to August 2020, 111 patients underwent ablation of APs. Dual-chamber maps were created in 50 patients (median age 15 [10-54], 32 male [64.0%]), while 61 patients underwent radiofrequency (RF) ablation with conventional single-chamber 3D maps. The background characteristics and procedural details were compared between the dual-chamber mapping group and the conventional single-chamber mapping group. Results The number of RF applications (median [IQR]; 1.0 [1.0-3.0] vs. 3.0 [1.0-6.0], p = .0023), RF time (median [IQR], s; 9.2 [2.0-95.7] vs. 95.6 [4.1-248.7], p = .0107), and RF energy (median [IQR], J; 248.4 [58.7-3328.2] vs. 2867.6 [134.2-7728.4], p = .0115) were significantly lower in the dual-chamber group. The fluoroscopy time (median [IQR], min; 19.9 [14.2-26.1] vs. 26.5 [17.7-43.4], p = .0025) and fluoroscopy dose (median [IQR], mGy; 52.5 [31.3-146.0] vs. 119.0 [43.7-213.5], p = .0249) were also significantly lower in the dual-chamber than single-chamber mapping group. Conclusion The dual-chamber mapping was useful for ablating accessory pathways and reducing the number of RF applications, total RF energy, and radiation exposure as compared with traditional mapping techniques.

Cell mechanical properties may undergo changes as a response to external stimuli or altered environment. Being able to map the mechanical properties over an entire cell in a contact-free and label-free manner is crucial to avoid affecting the measurements. Brillouin imaging is a non-invasive all-optical modality that can provide a distribution map of high-frequency elastic modulus and viscosity. In this report we first provide an overview of prior Brillouin cell imaging studies. We then demonstrate viscoelastic 2D and 3D cell imaging capabilities of a molecular filter-based Brillouin imaging system, with a first-time imaging application of multi-excitation (ME) Brillouin elastography.

BACKGROUND A novel steerable sheath visualized on a three-dimensional mapping system has become available in this era in which a durable pulmonary vein (PV) isolation (PVI) with reduced fluoroscopy is required. METHODS In 60 patients who underwent a PVI with a visualized sheath (n = 30) and non-visualized conventional sheath (n = 30), the fluoroscopic time and catheter stability during the PVI were analyzed. RESULTS The fluoroscopic time during the transseptal access (0 [0, 0.1] vs. 1.4 [0.8, 2.3] minutes, P

Introduction Detail 3D mapping have been useful for effective radiofrequency catheter ablation. Rhythmia system can create the atrio-ventricular dual chamber mapping, which reveals the atrial and ventricular potentials all at once in the same map. The aim of this study was to investigate the utility of Rhythmia system for catheter ablation of accessory pathways (AP). Methods From July 2015 to August 2020, 111 patients underwent ablation of APs. The dual chamber mappings were created in 50 patients [median age 15 (10-54), 32 male(64.0%)], while 61 patients underwent the radiofrequency (RF) ablations with conventional single chamber 3D mappings. The background characteristics and procedure details were compared between the dual chamber mapping group and conventional single chamber mapping group. Results The number of RF application [1 (1-3) vs 3 (1-6), p=0.0023], RF time [9.2 (2.0-95.7) vs 95.6 (4.1-248.7), p=0.0023], RF energy [248.4 (58.7-3328.2) vs 2867.6 (134.2-7728.4), p=0.0115] were significantly lower in dual chamber group. Fluoroscopy time [19.9 (14.2-26.1) vs 26.5 (17.7-43.4), p=0.0025], and fluoroscopy dose [52.5 (31.3-146.0) vs 119.0 (43.7-213.5), p=0.0249] were also significantly lower than in single chamber mapping group. Conclusion The dual chamber mappings were useful for effective ablation with reducing the radiation exposure.

Identifying distinct normal extracellular matrix (ECM) features from pathology is of the upmost clinical importance for laryngeal diagnostics and therapy. Despite remarkable histological contributions, our understanding of the vocal fold (VF) physiology remains murky. The emerging field of non-invasive 3D optical imaging may be well-suited to unravel the complexity of the VF microanatomy. This study focused on characterizing the entire VF ECM in length and depth with optical imaging. A quantitative morphometric evaluation of the human vocal fold lamina propria using two-photon excitation fluorescence (TPEF), second harmonic generation (SHG), and optical coherence tomography (OCT) was investigated. Fibrillar morphological features, such as fiber diameter, orientation, anisotropy, waviness and second-order statistics features were evaluated and compared according to their spatial distribution. The evidence acquired in this study suggests that the VF ECM is not a strict discrete three-layer structure as traditionally described but instead a continuous assembly of different fibrillar arrangement anchored by predominant collagen transitions zones. We demonstrated that the ECM composition is distinct and markedly thinned in the anterior one-third of itself, which may play a role in the development of some laryngeal diseases. We further examined and extracted the relationship between OCT and multiphoton imaging, promoting correspondences that could lead to accurate 3D mapping of the VF architecture in real-time during phonosurgeries. As miniaturization of optical probes is consistently improving, a clinical translation of OCT imaging and multiphoton imaging, with valuable qualitative and quantitative features, may have significant implications for treating voice disorders.

Background. The burden and persistence of atrial fibrillation (AF) have been associated with the presence and extent of left atrial (LA) fibrosis. Recent reports have implicated an association between the extent of LA fibrosis and the outcome of pulmonary vein isolation (PVI). We aimed to analyse the value of an automated scar quantification method in the prediction of success following PVI. Methods. One hundred and nine consecutive patients undergoing PVI for paroxysmal or persistent AF were included in our observational study with a 2-year follow-up. Prior to PVI, patients underwent high-definition LA electroanatomical mapping, and scar burden was quantified by automated software (Voltage Histogram Analysis, CARTO 3, Biosense Webster), then classified into 4 subgroups (Dublin Classes I-IV). Recurrence rates were analysed on and off antiarrhythmic drug therapy (AAD), respectively. Results. The overall success rate was 74% and 67% off AAD at 1- and 2-year follow-up, respectively. Patients with Dublin Class IV had significantly lower success rates ( p = 0.008 , off AAD). Dublin Class IV ( OR = 2.27 , p = 0.022 , off AAD) and the presence of arrhythmia in the blanking period ( OR = 3.28 , p = 0.001 , off AAD) were the only significant predictors of recurrence. The use of AAD did not affect these results. Conclusions. We propose a classification of low voltage areas based on automated quantification by software during 3D mapping prior to PVI. Patients with high burden of low voltage areas (>31% of

Purpose: Clinical drawings are integral part of image-guided adaptive brachytherapy (IGABT) of cervical cancer. It was used in EMBRACE study protocol as a useful tool. In our study clinical drawings from EMBRACE study were modified to include scales in all the dimensions for more accurate representation of various tumor related volumes. The aim of the present study was to understand patterns of tumor regression and relationship between gross tumor at diagnosis (GTVD) and high-risk clinical target volume (CTV-T-HR)/intermediate-risk clinical target volume (CTV-T-IR) in brachytherapy (BRT), using modified clinical drawings. Material and methods: 42 cervical cancer patients, staged as FIGO IIB-IIIB according to EMBRACE study, were enrolled. Advanced schematic 3D mapping diagram (3D-MD) in axial, coronal, and sagittal orientations, with a measurement scale (grid with 10 mm distance) for precise assessment and documentation was applied (through MRI at diagnosis and during brachytherapy). Dimensions, including height, width, and thickness as well as volumes (GTVD, CTV-T-HR and CTV-T-IR) were compared both qualitatively and quantitatively. Results and conclusions: We found qualitative and quantitative correlation of the dimensions of final CTV-T-HR with initial GTVD. Meticulous mapping of tumor volumes can provide useful insights to CTV-T-HR volume during brachytherapy.

Multimodal picture integration has been developed for improvements of visualization of interventional procedure in congenital and structural heart disease. 3D rotational angiography (3DRA) was used for that purpose in the past, and a 3D dataset was than imposed as an overlay for fluoroscopy. But 3DRA includes a 180° turn of the X-ray arm in order to generate a 3D dataset, including additional contrast application of 4–5 s, rapid pacing, and preparation of the catheterization lab.

Radiofrequency ablation of paroxysmal AF is Class I indication for drug refractory, symptomatic cases. In this case we did it for a highly symptomatic lady using CARTO 3D mapping system.

LVH (left ventricular hypertrophy) is one of the most common presentations in aortic stenosis and sometimes it would be missed to evaluate for other causes of the LVH in the presence of AS. Combination of AS and hypertrophic CMP is not common too. In this case of such combination, HCM was missed until presentation with VT and apical aneurysm.