Uncovering the Invisible: Role of High Density Catheters in recognizing
fractionated signals in Pulmonary vein isolation.
Abstract
The HD-grid multipolar mapping catheter has emerged as an invaluable
tool for greater effectiveness of pulmonary vein isolation (PVI). In the
cases described below, fractionated signals seen with the HD-grid
catheter at the LAA and LSPV junction were ablated. These signals likely
would not be visualized with conventional catheters and may cause
recurrences due to incomplete PVI. The directional sensitivity
limitations of bipolar electrogram recordings and the unique anatomy of
the LAA-LSPV ridge further contribute to the challenge of evaluating
pulmonary vein isolation. The HD-grid catheter’s ability to record
bipoles parallel and perpendicular to the catheter splines and its
high-density mapping capabilities provide a superior means of
identifying gaps in ablation and detecting the low-voltage isthmus.
Furthermore, factors such as ablation quality, catheter stability, and
the thickness of the LAA-LSPV ridge influence the presence of
fractionated signals and the success of PVI. Incorporating pre-procedure
imaging modalities such as CT or MRI and real-time intracardiac
echocardiography could enhance the tailored approach to address these
challenges. Future developments in HD-grid technology, including contact
force measurement during mapping, may offer additional insights into the
nature of these signals. This case series highlights the significance of
utilizing the HD-grid catheter for detailed interrogation of the
LAA-LSPV ridge, ultimately leading to more effective PVI and improved
outcomes in patients with afib