Before the procedure, any antiarrhythmic drugs were stopped for five half‐lives and anticoagulation reached its standard level. The surgeries were performed under fentanyl analgesia. Coronary sinus electrodes were placed through the left femoral vein of the patient. Atrial septal puncture was performed via femoral vein under X‐ray fluoroscopy. Two Swartz sheaths were delivered into the left atrium. After selective pulmonary vein angiography, with the assistance of the Carto system (Biosense Webster, Diamond Bar, CA), a three‐dimensional anatomical model of the left atrium was established and circular linear bilateral pulmonary vein ablation was performed. After completion, the pulmonary vein segment with the most advanced pulmonary vein potential was searched under the guidance of the Lasso electrode, and the corresponding part on the ablation ring was supplemented for ablation. Radiofrequency ablation endpoint: complete disappearance of ipsilateral pulmonary vein potential or left atrium‐pulmonary vein conduction bidirectional block, and there is no recovery for at least 30 minutes. During the procedure, heparin was used to maintain the activated clotting time of whole blood at 250–300 seconds.
Carto system
Manufactured by Johnson & Johnson
Sourced in United States
The CARTO system is a medical device designed for cardiac mapping and navigation. It provides physicians with real-time, three-dimensional visualization of a patient's cardiac anatomy and electrical activity during procedures. The system's core function is to assist healthcare professionals in the diagnosis and treatment of various cardiac conditions.
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Lab products found in correlation
Ensite velocity system, by Abbott (3 mentions)
Navistar thermocool, by Johnson & Johnson (3 mentions)
Ensite navx system, by Abbott (2 mentions)
Advisor hd grid mapping catheter, by Abbott (1 mentions)
Pentaray catheter, by Johnson & Johnson (1 mentions)
Navistar catheter, by Johnson & Johnson (1 mentions)
Prucka cardiolab electrophysiology system, by GE Healthcare (1 mentions)
Acunav, by Johnson & Johnson (1 mentions)
Tacticath, by Abbott (1 mentions)
Thermocool smarttouch, by Johnson & Johnson (1 mentions)
Pentaray, by Johnson & Johnson (1 mentions)
Navx mapping system, by Abbott (1 mentions)
Arctic front advance, by Medtronic (1 mentions)
Agilis, by Abbott (1 mentions)
28 protocols using carto system
1
Pulmonary Vein Isolation Procedure
2
Catheter Ablation Procedure with Transesophageal Ultrasound Guidance
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All patients underwent a catheter ablation under general anesthesia or deep sedation. A right femoral access was used to advance the catheters. Transseptal puncture was performed guided by transesophageal ultrasound imaging. Prior to any ablations a high-density LA EAM was recorded during sinus rhythm using the Advisor™ HD Grid Mapping Catheter with the EnSite Velocity system (Abbott, St. Paul, Minnesota, USA) or the Pentaray catheter with the CARTO system (Biosense Webster, Diamond Bar, CA, USA). Field scaling was enabled during all EnSite procedures. Patients were treated and observed for 24 h according to routine clinical practice. EAM anatomies were exported for offline alignment and analysis.
3
Electroanatomic Mapping of Right Ventricle
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Electroanatomic mapping of the RV was performed using CARTO system (Biosense Webster). At least 150 mapping points were sampled with an irrigated-tip Navi-Star catheter (Biosense Webster). Bipolar and unipolar electrograms were analysed. Reference values for identifying normal endocardial bipolar and unipolar signals were defined as >1.5 and >5.5 mV, respectively.
4
Contact-Force Analysis for Posterior Pulmonary Vein Ablation
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The following parameters were extracted from the CARTO system (Biosense Webster, Inc. Irvine, CA, USA) for further analyses: contact-force (g), energy (J) and ablation duration(s). The force-time-integral (g·s) and the force-power-time-integral (g·J) were calculated according to the following formulas:
Contact-force parameters were assessed for ablation applications at the posterior segments of the WACA line, e.g., postero-superior and postero-inferior around the left- and right-sided PVs (Figure 2 ).
Contact-force parameters were assessed for ablation applications at the posterior segments of the WACA line, e.g., postero-superior and postero-inferior around the left- and right-sided PVs (
5
Catheter Ablation of Left Anterior Fascicular PVC
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Left ventricle geometry and activation mapping via a retrograde approach were created by 3-D mapping (CARTO system, Biosense-Webster Inc., Diamond Bar, CA; or EnSite Velocity System, St Jude Medical Inc., St Paul, MN, United States). Activation mapping during PVC was performed along the LAF to identify the earliest PP by 3D activation mapping. As a result, radiofrequency ablation energy utilizing a 4-mm non-irrigated catheter was delivered at the earliest PP during PVC. The power output was titrated to 30 W with a maximum target temperature of 50–60°C for 60–120 s. If the origin site was closer to the distal left bundle branch, the power output was started at 10 W and titrated to 20 W to avoid left bundle branch injury. Acute procedural success was defined as the termination of the LAF-PVC during ablation and the absence of arrhythmias within 30 min of the final radiofrequency ablation application despite programmed electrical stimulation with isoproterenol infusion.
6
Comprehensive Atrial Fibrillation Catheter Ablation
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We used the Prucka CardioLab™ Electrophysiology system (General Electric Medical Systems, Inc., Milwaukee, WI, United States) to record the intracardiac electrograms and generated 3D electroanatomical maps (NavX, Abbott, Inc., Chicago, IL, United States; CARTO system, Biosense Webster, Diamond Bar, CA, United States) using a circumferential PV-mapping catheter through a long sheath. The 3D electroanatomical maps were merged with 3D spiral CT images. We conducted transseptal punctures and obtained multi-view pulmonary venograms. Systemic anticoagulation was conducted with intravenous heparin to maintain an activated clotting time of 350–400 s during the procedure. An open-irrigated tip catheter (30–60 W; 47°C) was utilized for the AFCA. The CPVI was conducted during the de novo procedure with bidirectional block. Cavotricuspid isthmus block was generated for most patients during the procedure unless there was an atrioventricular conduction disease. We performed an additional empirical linear ablation including a roof line, posterior interior line (posterior box lesion), anterior line, left lateral isthmus ablation, right atrial ablation, or complex fractionated electrogram ablation at the operator’s discretion.
7
Cavotricuspid Isthmus Ablation for CCW-AFL
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Antiarrhythmic drugs were discontinued for at least 5 half-lives before procedure, except the ß-blockers for rate control. Electrophysiological study was performed under local anesthesia. Spontaneous or induced CCW-AFL was recorded. Activation mapping was performed by using a three-dimensional mapping system [Carto system (Biosense-Webster, Diamond Bar, CA) or EnSite NavX system (Abbott, Abbott Park, IL)] and cavotricuspid isthmus-dependent CCW-AFL was confirmed with entrainment mapping. Under the guidance of the three-dimensional mapping system, an irrigated catheter was used to perform linear ablation between the tricuspid annulus and the inferior vena cava. Bidirectional block across the line was adopted as ablation endpoint.
8
PV Mapping and Ablation Procedure Protocol
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All patients underwent an electrophysiological study in the fasting state under conscious sedation. A 20‐pole catheter was inserted through the right jugular vein (BeeAT® Japan Lifeline). The proximal portion of the catheter was positioned along the superior vena cava and crista terminalis, and the distal portion was positioned in the coronary sinus (CS) for pacing and internal cardioversion.
Following a trans‐septal puncture under guidance with an intracardiac echocardiography catheter (5.5–10 MHz, 8Fr, AcuNav™, Biosense Webster), two or three long sheaths (SL1®, AF Division, St. Jude Medical) were introduced into the LA via the same trans‐septal puncture site. After a left atriography was performed, 20‐pole circular mapping catheters (1–5–1 mm interelectrode spacing, 20 mm in diameter, and/or 1–3.5–1 mm interelectrode spacing, 15 mm in diameter) and a 3.5 mm open‐irrigated‐tip ablation catheter (Navistar® Thermocool®, Biosense Webster or Thermocool Smarttouch®, Biosense Webster, or TactiCath™, Abbott) were positioned in the PVs for PV mapping (Figure1A ). In four patients, PV mapping was also performed with a 64‐pole basket catheter (Constellation®, Boston Scientific) (Figure 1B ). The electrophysiological studies were performed under support of an electroanatomical mapping system with the CARTO® system (Biosense Webster) or Ensite Velocity™ system (St. Jude Medical).
Following a trans‐septal puncture under guidance with an intracardiac echocardiography catheter (5.5–10 MHz, 8Fr, AcuNav™, Biosense Webster), two or three long sheaths (SL1®, AF Division, St. Jude Medical) were introduced into the LA via the same trans‐septal puncture site. After a left atriography was performed, 20‐pole circular mapping catheters (1–5–1 mm interelectrode spacing, 20 mm in diameter, and/or 1–3.5–1 mm interelectrode spacing, 15 mm in diameter) and a 3.5 mm open‐irrigated‐tip ablation catheter (Navistar® Thermocool®, Biosense Webster or Thermocool Smarttouch®, Biosense Webster, or TactiCath™, Abbott) were positioned in the PVs for PV mapping (Figure
9
Femoral Vein Access for 3D Mapping
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During the procedure, the patients were under local anesthesia; vascular access was obtained through the femoral vein. The 3-dimensional electro-anatomical mapping using the CARTO system (Biosense-Webster, Irvine, CA, USA; Johnson and Johnson, New Brunswick, NJ, USA) was implemented where applicable. Out of 35 procedures, 7 were performed before 2007. The procedure was considered effective if no SVA reappeared within 12 months of follow-up.
10
3D Voltage Mapping of Canine RVOT
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Voltage mapping was performed in dogs of both groups under the guidance of a 3-dimensional electroanatomical mapping CARTO system (Biosense Webster, CA, USA) under sinus rhythm. These procedures were achieved by taking about 1000 points and building a 3-dimensional conformation of the canine RVOT. Characteristics of the voltage transition zone of the RVOT from all the dogs were observed and analyzed.
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