Disclaimer: This advertorial is sponsored by Abbott
The Advisor™ HD Grid Mapping Catheter, Sensor Enabled™ (SE), is a unique mapping catheter that, when used with the EnSite Precision™ Cardiac Mapping System, allows bipole recording of waveforms in both the parallel and perpendicular planes, allowing for faster data collection in a given location.1 Cardiac Rhythm News spoke to Dr Kent Nilsson (Medical Director of the Electrophysiology Lab at Piedmont Heart Institute, Athens, Georgia, and Associate Professor of Medicine at Augusta University, Georgia, USA) about his experiences using the system and its advantages over other catheters.
When asked about his daily practice, Dr Nilsson shared that he primarily performs ablations, treating both simple cases (atrioventricular nodal re-entry tachycardia) and more complex issues such as ischemic ventricular tachycardia (VT). He estimates that about 70% of his patients present with a condition that is difficult to treat.
Initially, he tried the Advisor HD Grid Mapping Catheter, SE, for the most complex procedures, but was so impressed by its performance that he moved on to other applications. He explains: “Ischemic VT is typically a very difficult case. We liked the accuracy, the safety and the ability to move the catheter around, and you get a really high definition map. Based on the highly accurate maps generated with the Advisor HD Grid Mapping Catheter, SE, we were able to begin ablation more quickly and terminate the tachycardia rapidly. The benefits brought to the lab with the Advisor HD Grid Mapping Catheter, SE, were a lot more powerful than we thought they would be. Then I deployed it in an atrial fibrillation (AF) case. We started making observations and found that we were seeing a lot of low amplitude potentials that we hadn’t found before.”
The catheter consists of 16 electrodes arranged in a 4 × 4 grid. When combined with the software of the EnSite Precision™ Cardiac Mapping System, the design allows mapping of both orthogonal and perpendicular electrocardiogram signals for every bipole.
“With traditional linear mapping catheters, if an impulse signal is moving down the electrode you are going to get a really strong signal, whereas if it is moving perpendicular to the electrode you get no signal whatsoever. There may be areas of interest that you would miss as they are low amplitude and perpendicular to a traditional catheter. Oftentimes, these signals are really complex and fractionated, indicating potential ablation sites. With the Advisor HD Grid Mapping Catheter, SE, you are able to acquire an enormous amount of data very quickly and very accurately, and to see things you weren’t able to see before. If you are looking for specific areas of slow conduction in complex atrial flutters, the algorithm automatically chooses the electrogram with the highest amplitude for each pair; you can see the best signal and the resolution is a lot higher. No other catheter does that.”
With Advisor HD Grid Mapping Catheter, SE, mapping technology, greater mapping density creates opportunities for rapid,1 accurate2 model creation.
“Case times have been cut using the HD Grid,” Dr Nilsson declares. “I have anticipated spending four or five hours on some patients, and finished in 45 minutes. And because you are able to acquire so much data, and the data is more accurate, procedural success goes up.”
Dr Nilsson has mapped over 175 cases with the Advisor HD Grid Mapping Catheter, SE, and outlines the main arrhythmias in which he has used it: “One is ventricular tachycardia — either ischemic or non-ischemic VTs. The second area it has been really helpful for is atypical atrial flutters and atrial tachycardias. And third, we routinely use it in AF ablation.”
In mapping VTs, the Advisor HD Grid Mapping Catheter, SE, has allowed Dr Nilsson to delineate scar borders and potential ablation sites, as well as identify critical isthmuses: “If the patient is in VT at the time we start the procedure, we are able to map that critical spot a lot faster than with the traditional mapping techniques.”
Mapping atypical atrial flutters and atrial tachycardias with the 4 × 4 grid provides a more complete map, he says. “In atrial tachycardia you are looking for a very specific spot that is firing early, and the grid-like structure rapidly brackets the entire area. You are able to identify the site of early activation much quicker than you would do with a traditional catheter.”
Atypical atrial flutters often occur following a previous ablation: “These are some of the most vexing cases. With atypical atrial flutters you are looking for the critical isthmus, for areas where there is slow conduction. The Advisor HD Grid Mapping Catheter, SE, is phenomenal at identifying it very rapidly.”
And for AF, he says: “As more and more people have gained experience with the Advisor HD Grid Mapping Catheter, SE, I think it is catching on as one of the preferred mapping catheters.” He cites four reasons for this.
The first according to Dr Nilsson is its pliability: “The Advisor HD Grid Mapping Catheter, SE, is completely floppy; you would have to be pushing really hard to cause any damage.”
The second is its ability to detect low amplitude potentials that, Dr Nilsson says, “I don’t think we were picking up before. This isn’t just my observation; other high volume users are seeing the same thing. We just never saw them with traditional spiral catheters. Whether eliminating these potentials translates into improved outcomes has yet to be proven.”
Third, its high resolution allows gaps to be identified quickly. Successful treatment of AF depends on closing the gap between pulmonary vein isolation and pulmonary vein reconnection: “In the past, if we picked the site of earliest activation and said, ‘this is where the gap is’, it turns out that it would not be there, it would be to the left or the right of that.”
Fourth, and finally, the accuracy2 of the catheter minimizes the amount of ablation required following thorough endocardial substrate mapping. “Finding that critical point to ablate had been really difficult. There were a lot of epicardial tracks that we didn’t know about or appreciate before. Now, you can identify where the epicardial fibres are coming in and get that one particular spot with a single lesion that takes 10 seconds, as opposed to extensive ablation.”
He concludes: “The Advisor HD Grid Mapping Catheter, SE, is an incredibly safe diagnostic and mapping catheter. In over 175 cases, I have had no complications attributable to the Advisor HD Grid Mapping Catheter, SE. It moves a lot easier than other catheters, especially manipulating around the left ventricle — it is a great catheter to work with.”
For more information about the Advisor™ HD Grid Mapping Catheter, SE, go to https://www.cardiovascular.abbott/us/en/hcp/products/electrophysiology/advisor-hd-grid.html.
- Report on File. 90299533.
- Report on File. 90262900.
- Report on File. 90355919.
Refer to important safety information below:
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CAUTION: This product is intended for use by or under the direction of a physician. Prior to use, reference the Instructions for Use, inside the product carton (when available) or at manuals.sjm.com or eifu.abbottvascular.com for more detailed information on Indications, Contraindications, Warnings, Precautions and Adverse Events.
United States — Required Safety Information
Brief Summary: Prior to using these devices, please review the Instructions for Use for a complete listing of indications, contraindications, warnings, precautions, potential adverse events and directions for use.
Indications: The Advisor™ HD Grid Mapping Catheter, Sensor Enabled™, is indicated for multiple electrode electrophysiological mapping of cardiac structures in the heart, i.e., recording or stimulation only. This catheter is intended to obtain electrograms in the atrial and ventricular regions of the heart.
Contraindications: The catheter is contraindicated for patients with prosthetic valves and patients with left atrial thrombus or myxoma, or interatrial baffle or patch via transseptal approach. This device should not be used with patients with active systemic infections. The catheter is contraindicated in patients who cannot be anticoagulated or infused with heparinized saline.
Warnings: Cardiac catheterization procedures present the potential for significant x-ray exposure, which can result in acute radiation injury as well as increased risk for somatic and genetic effects, to both patients and laboratory staff due to the x-ray beam intensity and duration of the fluoroscopic imaging. Careful consideration must therefore be given for the use of this catheter in pregnant women. Catheter entrapment within the heart or blood vessels is a possible complication of electrophysiology procedures. Vascular perforation or dissection is an inherent risk of any electrode placement. Careful catheter manipulation must be performed in order to avoid device component damage, thromboembolism, cerebrovascular accident, cardiac damage, perforation, pericardial effusion, or tamponade. Risks associated with electrical stimulation may include, but are not limited to, the induction of arrhythmias, such as atrial fibrillation (AF), ventricular tachycardia (VT) requiring cardioversion, and ventricular fibrillation (VF). Catheter materials are not compatible with magnetic resonance imaging (MRI).
Precautions: Maintain an activated clotting time (ACT) of greater than 300 seconds at all times during use of the catheter. This includes when the catheter is used in the right side of the heart. To prevent entanglement with concomitantly used catheters, use care when using the catheter in the proximity of the other catheters. Maintain constant irrigation to prevent coagulation on the distal paddle. Inspect irrigation tubing for obstructions, such as kinks and air bubbles. If irrigation is interrupted, remove the catheter from the patient and inspect the catheter. Ensure that the irrigation ports are patent and flush the catheter prior to re-insertion. Always straighten the catheter before insertion or withdrawal. Do not use if the catheter appears damaged, kinked, or if there is difficulty in deflecting the distal section to achieve the desired curve. Do not use if the catheter does not hold its curve and/or if any of the irrigation ports are blocked. Catheter advancement must be performed under fluoroscopic guidance to minimize the risk of cardiac damage, perforation, or tamponade.