BACKGROUND: Hemodynamic instability hinders activation and entrainment mapping during ventricular tachycardia ablation. The Impella 2.5 microaxial flow device (MFD; Abiomed Inc., Danvers, MA, USA) is used to prevent hemodynamic instability during electrophysiologic study. However, electromagnetic interference (EMI) generated by this device can preclude accurate electroanatomic mapping. METHODS: Impella was placed in the left ventricle of 7 canines for circulatory support. Electroanatomic mapping during sinus rhythm, ventricular pacing, and ventricular fibrillation (VF) was performed using magnet- (CARTO3, Biosense Webster Inc., Diamond Bar, CA, USA) and impedance- (EnSite Velocity System/EnSite NavX, St. Jude Medical Inc., St. Paul, MN, USA) based systems. Distance from device to points with severe EMI precluding acquisition was compared to points with mild/no EMI. Two methods were used to reduce EMI: (1) titration of MFD performance, and (2) impedance-only mapping combined with manual annotation of activation. RESULTS: Severe EMI did not occur during impedance-based mapping. Severe EMI was observed using CARTO3 at 9.4% of all points attempted at maximum performance level (P8) of device. Severe EMI occurred at points closer to device (40.1 ± 16.8 mm) versus (55.5 ± 20.0 mm) for mild/no EMI, P < 0.0001. Severe EMI using CARTO3 was resolved by either (1) reduction of performance from P8 to P6 or (2) impedance-only mapping with manual annotation. CONCLUSION: Concurrent use of MFD caused EMI to prevent acquisition of points with magnet-based mapping. Predictors for EMI were distance from device and performance level. Temporary reductions to P6 or impedance-only mapping are 2 methods to resolve EMI.
BACKGROUND: Hemodynamic instability hinders activation and entrainment mapping during ventricular tachycardia ablation. The Impella 2.5 microaxial flow device (MFD; Abiomed Inc., Danvers, MA, USA) is used to prevent hemodynamic instability during electrophysiologic study. However, electromagnetic interference (EMI) generated by this device can preclude accurate electroanatomic mapping. METHODS: Impella was placed in the left ventricle of 7 canines for circulatory support. Electroanatomic mapping during sinus rhythm, ventricular pacing, and ventricular fibrillation (VF) was performed using magnet- (CARTO3, Biosense Webster Inc., Diamond Bar, CA, USA) and impedance- (EnSite Velocity System/EnSite NavX, St. Jude Medical Inc., St. Paul, MN, USA) based systems. Distance from device to points with severe EMI precluding acquisition was compared to points with mild/no EMI. Two methods were used to reduce EMI: (1) titration of MFD performance, and (2) impedance-only mapping combined with manual annotation of activation. RESULTS: Severe EMI did not occur during impedance-based mapping. Severe EMI was observed using CARTO3 at 9.4% of all points attempted at maximum performance level (P8) of device. Severe EMI occurred at points closer to device (40.1 ± 16.8 mm) versus (55.5 ± 20.0 mm) for mild/no EMI, P < 0.0001. Severe EMI using CARTO3 was resolved by either (1) reduction of performance from P8 to P6 or (2) impedance-only mapping with manual annotation. CONCLUSION: Concurrent use of MFD caused EMI to prevent acquisition of points with magnet-based mapping. Predictors for EMI were distance from device and performance level. Temporary reductions to P6 or impedance-only mapping are 2 methods to resolve EMI.
Authors: Marc A Miller; Srinivas R Dukkipati; Alexander J Mittnacht; Jason S Chinitz; Lynn Belliveau; Jacob S Koruth; J Anthony Gomes; Andre d'Avila; Vivek Y Reddy Journal: J Am Coll Cardiol Date: 2011-09-20 Impact factor: 24.094
Authors: T Jared Bunch; Andy Darby; Heidi T May; Michael Ragosta; D Scott Lim; Angela M Taylor; John P DiMarco; Gorav Ailawadi; James R Revenaugh; J Peter Weiss; Srijoy Mahapatra Journal: Europace Date: 2011-11-11 Impact factor: 5.214
Authors: Vivek Y Reddy; Matthew R Reynolds; Petr Neuzil; Allison W Richardson; Milos Taborsky; Krit Jongnarangsin; Stepan Kralovec; Lucie Sediva; Jeremy N Ruskin; Mark E Josephson Journal: N Engl J Med Date: 2007-12-27 Impact factor: 91.245
Authors: Francis E Marchlinski; Erica Zado; Sanjay Dixit; Edward Gerstenfeld; David J Callans; Henry Hsia; David Lin; Hemal Nayak; Andrea Russo; Ward Pulliam Journal: Circulation Date: 2004-10-11 Impact factor: 29.690
Authors: Andrew C Miller; Annicka C Evans; James Revenaugh; J Peter Weiss; Bruce B Reid; Abdallah G Kfoury Journal: HeartRhythm Case Rep Date: 2015-09-30