4/5D Integrated Mapping for Atrial Fibrillation Ablation

The majority of AF ablative cases are guided by 2D fluoroscopy with an additional dimensionality added by circular lasso-type Catheters. While this may be sufficient for simple pulmonary vein isolation, recurrence rates in paroxysmal patients remain as high as 20-30%. Many patients have extensive underlying disease and more chronic atrial fibrillation not amenable to simple pulmonary vein isolation. Four/five dimensional imaging provides the venue for the chronicling of physiology (such as CAFE and ganglion plexus activity) within the context of 3 spatial dimensions. In addition, real-time registration may be of even greater importance in guiding the ablation of more complicated atrial fibrillation types. This may be even more important, as more sophisticated energy sources are developed, including those to be delivered from outside of the body. Studies have already demonstrated an improvement in procedure times with a mapped approach, while others demonstrate a reduction in fluoroscopic exposure. The use of 4/5D imaging is also critically important to realize the full potential of robotics, which can be programmed to deal with complicated structures. The same is true in the full integration of contact force sensing for ablative intervention. This report will chronicle experience to date with 3/4D mapping systems, as well as the progression in their application for contact sensing, complex electrogram-based ablation, robotic interventions, and for guiding extracorporeal energy deliveries.