Search

Abstract Nowadays, fluoroscopy is the standard tool used to help physicians during pacing lead implantation. However, its use entails significant radiation exposure for physicians and especially for patients. For the first time, the present case report describes the use of the electro‐anatomical mapping (EAM) navigation system KODEX‐EPD for cardiac resynchronization therapy (CRT) implantation. These findings suggest that CRT implantation guided by the KODEX‐EPD system is feasible and safe with the minimization of X‐ray and dye exposure.

Background: A novel 3D mapping system (KODEX‐EPD, EPD Solutions) enables catheter localization and real‐time 3D cardiac mapping. Objective: To evaluate left atrium (LA) anatomical mapping accuracy created by the KODEX‐EPD system during pulmonary vein isolation (PVI) compared with gold standard computed tomography (CT) images acquired from the same patients before the procedure. Methods: In 15 consecutive patients who underwent PVI, 3D mapping of the LA was created on the KODEX‐EPD system using the Achieve catheter. Pulmonary vein (PV), posterior wall, and appendage anatomy and diameters, were compared to the CT 3D reconstruction measured on the CARTO 3 system. Measurements were done independently by two physicians in each method. Linear correlation and agreement between CT and EPD measurements were assessed by Spearman correlation and Bland‐Altman plot. Results: Mean LA mapping time was 7.7 ± 3.6 min. Very high interobserver correlation was found for both EPD and CT measurements (Spearman r =.9). High correlation (r =.75) was found between CT and EPD measurements. Bland‐Altman plot method revealed that measurements assessed by EPD were slightly higher than those assessed by CT. Mean difference was 3.5 mm, p <.01. In 2 (13.5%) patients each, disagreement regarding the presence of a left common PV and a right middle accessory vein anatomy was seen. Conclusion: The new KODEX‐EPD mapping system allows quick and accurate mapping of the LA with high correlation to CT imaging. Some differences in left common and accessory right middle vein anatomy were seen. [ABSTRACT FROM AUTHOR]

Nowadays, fluoroscopy is the standard tool used to help physicians during pacing lead implantation. However, its use entails significant radiation exposure for physicians and especially for patients. For the first time, the present case report describes the use of the electro‐anatomical mapping (EAM) navigation system KODEX‐EPD for cardiac resynchronization therapy (CRT) implantation. These findings suggest that CRT implantation guided by the KODEX‐EPD system is feasible and safe with the minimization of X‐ray and dye exposure. [ABSTRACT FROM AUTHOR]

An editorial is presented on Potential advantages of the KODEX‐EPD system as the fourth 3D mapping system for atrial fibrillation ablation. Topics include cardiac arrest in a randomized fashion could not definitely reveal the advantage of catheter ablation compared with medical therapy among patients with AF; and distinct dielectric properties of biological tissue by measuring voltages between body surface sensors and the catheters.

Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice with significant morbidity and mortality. The current guidelines and consensus documents on the management of AF state that pulmonary vein isolation (PVI) is a recommended strategy during the treatment of patients with drug-refractory symptomatic paroxysmal AF. The cornerstone of AF catheter ablation is the complete isolation of pulmonary veins by linear lesions around their antrum, either using point-by-point radiofrequency ablation or single-shot ablation devices like cryoballoon ablation (CBA). As the CBA still requires the use of fluoroscopy and iodine contrast, a novel 3D mapping system Kodex-EPD was used with the aim to reduce both fluoroscopy and contrast usage1,2. The feasibility and safety of fluoro-free ablation were tested. Differences in nurses’ interventions were also recorded in relation to the classic CBA procedure. During the 2-month period, 15 consecutive patients (9 males and 6 females) undergoing CBA were enrolled (age 60±11). Average time of patient preparation until transseptal puncture was 16±5 minutes while the average mapping time was 12±4 minutes. 7 procedures were performed completely without any use of fluoroscopy, and iodine contrast was used for a single pulmonary vein in only one patient. In all patients, pulmonary vein isolation was achieved without any periprocedural complications. Although on a small number of patients, it can be concluded that CBA with the support of a dielectric mapping system is safe, significantly reduces the need for fluoroscopy and contrast, and in a certain way represents additional engagement in terms of nursing interventions when preparing the patient for the procedure. [ABSTRACT FROM AUTHOR]

Background and Objectives: A novel wide-band dielectric mapping system, named as KODEX-EPD (EPD Solutions, Philips, Best, the Netherlands), was effectively used in the EA mapping for atrial fibrillation (AF) ablation. To date, only a few studies have concentrated on the application of the KODEX-EPD system for ablating supraventricular tachycardia or ventricular premature beats (VPBs) in human models. This study aims to assess the applicability and efficiency of a novel three-dimensional electro-anatomic (EA) mapping system to improve the success rate of ablation., Methods: This study included 11 consecutive patients who underwent ablation after EA mapping with the KODEX-EPD system., Results: All surgeries were successfully performed using the KODEX-EPD system, including 6 cases who underwent ablation of paroxysmal supraventricular tachycardia (PSVT), 2 cases who received ablation of VPBs from right ventricular outflow tract (RVOT), and 3 cases who underwent cryoablation of AF. For ablation of PSVT or VPBs, the operation time was 31.4 (range, 24.0-38.0) min, in which a median operation time of 2.9 min was used to create anatomic images, and the median fluoroscopic dose was 7.4 mGy. For ablation of AF, the operation time was 56.0 (range, 49.0-62.0) min, in which a median of 4.3 (range, 3.4-5.2) min was used for constructing left atrium map, and the median fluoroscopic dose was 15.0 mGy. The operation time and the fluoroscopic dose were greatly shortened for all surgeries., Conclusion: The KODEX-EPD system is an effective and safe tool to guide the EA mapping, leading to improvement in the success rate of ablation. It can promote the ablation process with the reduced fluoroscopic dose, and it is also a promising tool for complex surgeries., Competing Interests: Conflict of Interest Yingxian Sun is an Associate Editor-in-Chief of the journal. The article was subject to the journal's standard procedures, and peer review was handled independently of this editor and his research groups., (© 2022 Jian Li, Yu Hua, Lei Qiao, Bo Wang, Xuefeng Pang, He Jia, Yang Yu, Bo Yu, Yingxian Sun, Xingang Zhang, Yanli Chen, published by Sciendo.)