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Advances in Heart Imaging And Mapping Systems

by Steve S. Ryan, PhD

Perhaps the most important technical innovations in 2013 for A-Fib patients were the introduction of two new heart imaging and mapping systems. A third system, the Bioelectronic Catheter, represents a whole new technology with tremendous potential for A-Fib patients.
Patients wearing 'vest' lies down for the ECGI.

Patients wearing ‘vest’ lies down for the ECGI.

The ECGI System

The ECGI system, combined with a CT scan, produces a complete 3-D image of your heart along with identifying all the A-Fib-producing spots. Think of it as an ECG with 256 special high resolution electrodes rather than 12. It greatly reduces your ablation time and your radiation exposure. A day before your ablation, you simply don a special vest with 256 electrodes covering your upper torso, and lay down.

The 3-D image created is a road map of your heart with all the focal and rotor areas (A-Fib-producing spots) identified. During your ablation your EP simply ablates the “guilty” areas. Read my article: BAFS 2013: Non-Evasive Electrocardiographic Imaging (ECGI)

Topera-FIRMap catheter - three sizes

Topera-FIRMap catheter – three sizes

The FIRM System

The FIRM system uses a different approach to mapping the heart and the A-Fib producing spots. It uses a basket catheter inside the heart to map large areas in a single pass and reveal the location of foci and rotors. Read more of my article on the FIRM System… Why are these two technologies important? ECGI allows your imaging & mapping to be performed the day prior to your ablation, rather than during your ablation. This shortens the length of your ablation procedure.

In addition it reduces your radiation exposure and produces remarkable accurate 3D images of your heart and where A-Fib signals are coming from. The FIRM system, though performed during an ablation rather than before it, may be a significant improvement over the Lasso catheter mapping system now in current use. Both systems may mark a new level of imaging/mapping for A-Fib.

Flexible Biomechanical Balloon Catheter - photo credit: Dae-Hyeong Kim-University of Illinois

Flexible Biomechanical Balloon Catheter – photo credit: Dae-Hyeong Kim-University of Illinois

Stretchable Electronics Meets the Balloon Catheter

The merging of living systems with electronic systems is called “bioelectronics”. Key is a flexible, pliable circuit made from organic materials—the carbon-based building blocks of life. Bioelectronics have entered the EP lab with a prototype of a ‘bioelectronic catheter’, the marriage of a pliable integrated circuit with a catheter balloon.

In a mapping application, the deflated bioelectronic balloon catheter is slipped into the heart, then pumped up. The inflated integrated circuit conforms to the heart’s grooves and makes contact with hard-to-reach tissue. It can map a hundred electrical signals simultaneously, across a wider area and in far greater detail than had been previously possible. And it’s being developed to function in reverse.

For abaltion applications, instead of detecting current it can apply precise electrical burns. This is a potentially breakthrough technology that may change the way catheter mapping and ablation are performed. (Thanks to David Holzman for calling our attention to this ground-breaking research article.)

What a remarkable time in the history of A-Fib treatment! Three very different technologies are poised to radically improve the way A-Fib is detected, mapped and ablated. We’ll look back at 2013 as a watershed year for A-Fib patients.
References for this article

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Last updated: Sunday, February 15, 2015

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