High-Resolution Imaging of LA Anatomy Using a Novel Wide-Band Dielectric Mapping System: First Clinical Experience

Abstract

Objectives: This study presents the first report of high-resolution imaging of cardiac anatomy using a novel system.

Background: Recently, the wide-band dielectric mapping system Kodex was introduced.

Methods: This study included 20 consecutive patients with symptomatic atrial fibrillation or left atrial tachycardia who were scheduled for an ablation procedure and who underwent simultaneous left atrial mapping using the Kodex and CARTO 3 systems. Pulmonary vein angiograms served as a reference to compare the craniocaudal dimensions of the pulmonary vein ostia as depicted by either of the 2 mapping systems.

Results: Complete left atrial imaging was achieved within a median [first quartile; third quartile] of 9.7 [7.5; 12.8] min. Median procedure time was 97.5 [90; 112.5] min, and median total fluoroscopy time was 8.2 [5.7; 10.6] min, of which a median of 1.4 [1.1; 2.3] min were used during the creation of the left atrial map. High-resolution representations of left atrial anatomy were successfully created in all patients. Both the Kodex and CARTO measurements correlated well with fluoroscopy measurements, as reflected by Pearson's correlation coefficients (r) of 0.91 and 0.95, respectively. Bland-Altman plots revealed that, on average, Kodex measurements underestimated fluoroscopy measurements by 0.04 mm (95% limits of agreement of -5.72 and 5.64 mm), and CARTO measurements underestimated fluoroscopy measurements by 0.02 mm (95% limits of agreement of -3.61 and 3.57 mm).

Conclusions: Anatomic mapping of the left atrium using Kodex shows the potential to create computed tomography-like images without the need for additional periprocedural imaging.

Keywords: arrhythmia; atrial fibrillation; cardiac imaging; catheter ablation.