Cardiac arrhythmia management using a noncontact mapping multielectrode array

Abstract

Background: The multielectrode array (MEA) enables noncontact mapping of cardiac arrhythmias; our experience is reviewed and reported. Hypothesis: The MEA has a role as first line therapy in multiple arrhythmias. Methods: Retrospective and prospective analysis of all consecutive cases performed using the MEA over a 6 year period. Results: Electrophysiological study and catheter ablation, 46% under general anaesthesia, using radiofrequency (RF), cryothermal and low energy direct current (DC) was performed in 66 procedures on 31 females and 29 males, average age 50.2 yrs (19.3-81.6); 8 patients underwent multiple procedures. 24 patients (36%) had undergone past ablation for the same arrhythmia. A wide variety of arrhythmias from all chambers were treated, majority right atrial (56%) and right ventricular (29%). Procedural success was complete in 77.4% and partial/indeterminate in 11.3%, highest in right atrial tachycardia, right ventricular outflow tract ectopy and typical atrial flutter (79, 82 and 100%). RF energy was most commonly used (67%) and DC carried 100%success. Ablation was delivered at 'early activation' and 'breakout' in focal arrhythmias. In re-entrant circuits linear ablation transectingpath of activationextending to regions of functional/anatomic block was performed. Two of 7 complications were attributed to the MEA: groin haematomas. At mean 12.4 mo follow up 56% were arrhythmia free, 15% asymptomatic or minimally symptomatic and 12 patients had new arrhythmias. Conclusions: The MEA is effective, safe and suitable for first line therapy in multiple cardiac arrhythmias particularly in the right heart. Further study is warranted comparing it to other mapping techniques. © 2010 Wiley Periodicals, Inc.