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Position conventional catheters

This step is done in the same fashion as in conventional EP studies, although fewer catheters will generally be used.  During a typical left ventricular study catheters are placed in the apex of the right ventricle, at the bundle of His, and in the left ventricle for use during the 'Establish Geometry' step and for ablation.  During a typical right atrial study catheters are placed at the os of the coronary sinus vein, at the bundle of His or in the high right atrium, in the right ventricle, and an additional catheter in the right atrium for use during both the 'Establish Geometry' step and for ablation.

Position  ® catheter

The  ® is placed in the chamber in low-profile mode.  Once an appropriate position has been attained, the array is placed in high-profile mode, and the balloon is inflated with a mixture of saline and contrast to allow for easy viewing under fluoroscopy.

Establish geometry and landmarks

This step creates a 3D computer model of the heart chamber.  This model is used to show the isopotential and isochronal maps, and is also an integral part of the mathematics used to create the virtual electrograms.  The model is established by moving a contact catheter around the heart chamber.  The   3000® System tracks the movement of the catheter and records any points that are outside the bounds of the current model.  When a sufficient number of points have been collected (this takes approximately five minutes), a bicubic spline algorithm is applied to smooth the model into its final form.  The advantage of this approach is that it does not require the catheter to be placed at each site for multiple cardiac cycles.  In addition, the contoured model has been designed to accurately represent the chamber geometry.  A short video of the process is shown below.

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Click image to play GIF animation (258 KB)

Induce

At this point, the patient's clinical arrhythmia is induced, recorded and terminated.   Upon termination of the arrhythmia, the clinician may review for analysis the recorded arrhythmia.  Unlike conventional, sequential mapping techniques, hemodynamically unstable patients may be mapped with this system since the arrhythmia need only be present for one to two beats.

Identify

The recordings that were made during the previous step are reviewed to identify the target site for ablation.  The beginning of the QRS complex is selected, then the pathway is traced backwards in time to identify the site of earliest activation.  The 3D map feature in the system has been designed to assist the physician in identifying critical sites such as exit sites, pathways, and reentrant sites.  Areas of interest may be labeled to assist in guiding the ablation catheter to the site.  A short video of the process is shown below.

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Click image to play GIF animation (248 KB)

Navigate

Once the targeted site for ablation has been identified, the EnGuide™ signal is used to navigate the ablation catheter to that site.  When the EnGuide™ signal coincides with the previously labeled target ablation begins.   The navigational feature has been designed to assist the clinician in quickly navigating the catheter to the area of interest with reduced dependency on fluoroscopy.   A video of the process is shown below.

Click image to play GIF animation (190 KB)


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