PVI over SHAM procedure European Society of Cardiology PVI is an effective therapy in AF treatment ! #hotline #ESCCongress2024

#Epeeps should all ATs be entrained prior to ablation? Hear Gregory Michaud debate Nuno Cortez-Dias, MD PhD at #ATLASMapping next month in Dallas. Registration: form.jotform.com/242335608275155 Roderick Tung Mansour Razminia @MiguelVldrbno Abbott Cardiovascular

⁦Nuno Cortez-Dias, MD PhD⁩ in his element on Day 1 at #ATLASMapping working through a complex case with hand-on interactive map analysis.

🤩A new way to map PVCs⤵️ Meet the💥MECIE-mapping technique💥 Publication in HeartRhythm “Multielectrode catheter-induced ectopy mapping: a novel technique for ablation of infrequent premature ventricular contractions” With Karim Benali Konstantinos Vlachos Nuno Cortez-Dias, MD PhD Thread⤵️

Free access article link pubmed.ncbi.nlm.nih.gov/39455034/

For patients with infrequent PVCs, activation mapping is useless, and the only remaining technique to determine the SOO is pace-mapping, which has limited spatial resolution

We describe a novel mapping strategy for patients with infrequent PVCs, called “multielectrode catheter-induced ectopy mapping” (MECIE-mapping), aiming at performing a hybrid activation/template matching map by taking advantage of multielectrode catheter-induced arrhythmogenicity

Step 1⃣ Acquisition of a 12-lead ECG template of the clinical PVC into the mapping system

Step 2⃣ Setting a PVC activation map with a 95% matching concordance in the 3D mapping system, to selectively acquire the beats with >95% similarity to the template initially acquired

Step 3⃣Moving the catheter nearby the supposed SOO of the clinical PVC

Step 4⃣All the ectopic beats with < 95% of concordance with the clinical PVC are discarded, while those ectopic beats with ≥ 95% of concordance with the clinical PVC are automatically selected by the mapping software, analyzed in terms of LAT and displayed in an activation map

So, it is a LAT map from the ectopic beats generated by the multielectrode catheter! Since a given spline is generating the ectopic beat, it will display an early EGM starting way before QRS onset. All the EGMs adjacent spline are also analyzed and displayed in the LAT map

A movie (speed x2) to see a MECIE-map being generated. No PVCs before entering the RVOT, just mechanical beats generated and recorded if > 95% concordance

Step 5⃣ A map with a broad area of good LAT for mechanical PVCs with ≥ 95% concordance is generated. At this stage, those points with ≤ 96%, then ≤ 97%, and ≤ 98% concordance can be discarded, making the generated LAT map more precise

Here is a nice example of 95 to 99% MECIE-maps⤵️

🔥So in conclusion, stop seeing mechanical induced ectopic as an annoying phenomenon, and use it wisely to accurately spot the exact SOO of infrequent PVCs 😵Spoiler: it also works for PVC with higher burdens

Pulse Field Ablation - Farapulse Mapping. Yes or No? Dr. Diogo Cavaco and Dr. Nuno Cortez Dias discuss workflows and different strategies with or without the new mapping features #arritmias2025

Here we go 👇