Hybrid magneto – impedance based 3-D electro-anatomical mapping in a complex case of incessant left atrial tachycardia

Abstract

Electro-anatomical mapping (EAM) helps us to analyse the activation wave fronts arising from structures responsible for genesis of arrhythmias. With the ever growing subset of complex arrhythmias, it has become inevitable for the electrophysiologists to have an accurate anatomical representation of the substrate. The newer advances in 3D EAM mapping have made it possible to acquire precise geometry points for mapping and ablation. EAM systems are broadly based on two technologies: 1. Abbott EnSite Nav XTM, uses low level current applied through orthogonally placed electrodes. Mapping is then performed by these impedance based points. 2. Biosense Webster CARTOTM, uses low level magnetic fields to localise anatomic points for geometry creation [1]. While impedance based catheters give the operator the edge in being open platform, the proficiency of magnet based technology in accurate delineation of geometry especially in high impedance areas is well known. The newer Abbott EnSite PrecisionTM technology with ‘magnet sensor enabled’ catheters which were recently launched in India gives us the best of both technologies. Infact, EnSite PrecisionTM scores over its predecessor EnSite Nav X VelocityTM in two novel aspects: AutoMap® and AutoMark®. We describe a complex case of incessant left atrial tachycardia who underwent radiofrequency ablation using the latest Abbott EnSite PrecisionTM mapping system with ‘magnetic sensor-enabled