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Catheter ablation (CA) is an invasive adjunctive therapeutic option for atrial and ventricular arrhythmias, in uncontrolled cases, following optimal medical therapy.1,2 The validation of 3D mapping and its implementation into clinical usage has been a remarkable achievement in the field of complex ablation of scar-related ventricular tachycardia (VT) in the early 2000s.3 In the setting of atrial […]

Radiofrequency (RF) ablation involves delivering medium-to-high-frequency alternating current, which is electrically conducted to cardiac tissue that constitutes a part of the circuit. The unipolar circuitry contains the generator, transmission lines, catheter, cardiac tissue, interposed tissue and dispersive electrode (ground pad/indifferent electrode). Bipolar systems, whereby the RF current flows between two electrodes, either on the same […]

Introduction: Identifying ablation targets for persistent atrial fibrillation (PersAF) remains challenging. Dominant frequency (DF) and organization index (OI) of atrial electrograms (AEGs) are proposed to identify driver sites that contribute to AF perpetuation. This work aims to use DF and OI together to identify atrial regions with organised, fast activation rates based on electrophysiologic responses following […]

Introduction: In patients eligible for cardiac implantable electronic device (CIED) placement with the need of a high percentage of ventricular pacing, early indication for CIED placement able to deliver cardiac resynchronization therapy (CRT) is advantageous, because it may prevent a pacemaker syndrome (left ventricular ejection fraction deterioration in patients with apicoseptal right ventricular lead placement […]

Introduction: Understanding post-infarct VT substrate relies on a combination of voltage and activation mapping. These maps are often analysed separately. Omnipolar electrograms (Omni-EGMs) offer a novel approach to mapping, with local activation displayed as a vector. We describe an approach to characterize the post-infarct ventricular arrhythmic substrate using omni-vectors superimposed onto omni-voltage maps for review ‘in […]

Introduction: Conventional right ventricular pacing can cause left ventricular systolic dysfunction, heart failure symptoms and atrial fibrillation in the long run. Early upgrade to biventricular stimulation or physiological stimulation may be able to prevent these adverse outcomes. His bundle pacing (HBP) has several pitfalls which include lack of capture at acceptable thresholds, incremental threshold values […]

The clinical introduction of cardiac electrophysiology (EP) studies in the 1980s was a cornerstone in how to understand, diagnose and treat specific arrhythmias. Anatomic orientation and positioning of catheters was achieved by fluoroscopic guidance. Signals were derived from intracardiac EP-catheters and interpretation of these, in combination with specific stimulation manoeuvres, led to successful therapies. Increasing […]

Radiofrequency catheter ablation (RFA), introduced in the 1980s, represents a major advancement in the field of electrophysiology.1,2 With reported acute procedural success rates of up to 95 %, catheter-based ablation has become the standard of care for paediatric supraventricular tachycardias (SVTs).3,4 Traditionally, electrophysiology catheterisation studies including RFA have been guided fluoroscopically. However, exposure to ionising […]

Background: We have previously developed the sense protocol functional substrate mapping technique for ventricular tachycardia (VT) ablation. However, functional substrate characterization can involve protracted mapping time. Purpose: We incorporated the integration of magnetic resonance imaging (MRI) data using ADAS-3D software into the mapping workflow to integrate structural mapping information into the functional mapping substrate characterization […]