© 2014 Boston Scientific Confidential EP-242101-AA APR2014 IntellaTip MiFi ™ XP Ablation Catheter Atrial Flutter Playbook Information for the use in countries.

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Presentation transcript:

© 2014 Boston Scientific Confidential EP AA APR2014 IntellaTip MiFi ™ XP Ablation Catheter Atrial Flutter Playbook Information for the use in countries with applicable Health Authority product registrations.

© 2014 Boston Scientific Confidential EP AA APR2014 The Power of the Mini-electrodes Using IntellaTip MiFi ™ XP multi-sense technology for Atrial Flutter cases Entrainment & Pacing Maneuvers Entrainment & Pacing Maneuvers Entrainment & Pacing Maneuvers Entrainment & Pacing Maneuvers CTI Identification CTI Identification CTI Identification CTI Identification HIS Recording HIS Recording HIS Recording HIS Recording Contact Assessment Contact Assessment Contact Assessment Contact Assessment Real-Time Ablation Feedback Real-Time Ablation Feedback Real-Time Ablation Feedback Real-Time Ablation Feedback Post-Ablation Gap Analysis Post-Ablation Gap Analysis Post-Ablation Gap Analysis Post-Ablation Gap Analysis Identify tip location with mini-electrodes vs. conventional bipoles Isolate entrainment circuit with mini-electrodes vs. conventional bipoles Analyze mini-electrode saturation recovery period vs. conventional bipoles Confirm appropriate ablation sites with mini-electrodes Evaluate tissue contact with enhanced near-field signals Reveal lesion progress through EGM attenuation on mini-electrodes Evaluate lesion gaps with mini-electrodes Click for more information.

© 2014 Boston Scientific Confidential EP AA APR2014 HIS Recording

© 2014 Boston Scientific Confidential EP AA APR2014 MiFi vs. Common Bipoles – His?

© 2014 Boston Scientific Confidential EP AA APR2014 Another HIS Recording Courtesy of University of Alabama Birmingham

© 2014 Boston Scientific Confidential EP AA APR2014 Entrainment and Pacing Maneuvers

© 2014 Boston Scientific Confidential EP AA APR2014 Pace slightly faster than the tachycardia from an area believed to be within the circuit, the CTI, using the ablation catheter! The pacing output must be adequate to capture the chamber. When pacing is stopped, the timing to the next intrinsic beat should be very near the Tachycardia Cycle Length (TCL). Kalman J et al. Circulation 1996;94: An Oversimplified Explanation of Entrainment Circuit Pacing Site Timing is measured on the pacing channel. Therefore, the pacing channel must recover at a timing interval less than the Tachycardia Cycle Length! (TCL)

© 2014 Boston Scientific Confidential EP AA APR2014 Pacing from the ABL D PPI?TCL? Returning to Baseline Courtesy of University of Alabama Birmingham

© 2014 Boston Scientific Confidential EP AA APR2014 Pacing from MiFi pair 1-2 Final Pacing Impulse Returning to Baseline **No Saturation on ABL D Courtesy of University of Alabama Birmingham

© 2014 Boston Scientific Confidential EP AA APR2014 Traditional Entrainment From Ablation 5mA – Saturation on CBP Courtesy of University of Alabama Birmingham

© 2014 Boston Scientific Confidential EP AA APR2014 Traditional Entrainment From Ablation 2mA – No Capture Courtesy of University of Alabama Birmingham

© 2014 Boston Scientific Confidential EP AA APR2014 Entrainment From Mini 2mA – Capture Courtesy of University of Alabama Birmingham

© 2014 Boston Scientific Confidential EP AA APR2014 Entrainment From Mini 1mA – Capture Courtesy of University of Alabama Birmingham

© 2014 Boston Scientific Confidential EP AA APR2014 CTI Identification

© 2014 Boston Scientific Confidential EP AA APR2014 MiFi Catheter on CTI? Courtesy of William Maddox, MD, FHRS, Assistant Professor of Medicine, Georgia Regents University

© 2014 Boston Scientific Confidential EP AA APR2014 CTI? Courtesy of University of Alabama Birmingham

© 2014 Boston Scientific Confidential EP AA APR2014 CTI

© 2014 Boston Scientific Confidential EP AA APR2014 Fluoro Image Comparison Common Bipole CTI PlacementMiFi CTI Placement Courtesy of University of Alabama Birmingham

© 2014 Boston Scientific Confidential EP AA APR2014 Catheter Positioning Based on MiFi VPulled back to AAV Junction

© 2014 Boston Scientific Confidential EP AA APR2014 True CTI Another Example of CTI Identification Abl:ON

© 2014 Boston Scientific Confidential EP AA APR2014 Contact Assessment

© 2014 Boston Scientific Confidential EP AA APR2014 Perpendicular Contact? Courtesy of William Maddox, MD, FHRS, Assistant Professor of Medicine, Georgia Regents University

© 2014 Boston Scientific Confidential EP AA APR2014 MiFi Good Contact – ME 1 Touching Courtesy of University of Alabama Birmingham

© 2014 Boston Scientific Confidential EP AA APR2014 More Parallel Contact – SVC pullback Parallel Tissue Contact with ME 1 in Primary Contact

© 2014 Boston Scientific Confidential EP AA APR2014 Real-Time Ablation Feedback

© 2014 Boston Scientific Confidential EP AA APR2014 EGM Attenuation – CBP vs. MEs Courtesy of William Maddox, MD, FHRS, Assistant Professor of Medicine, Georgia Regents University

© 2014 Boston Scientific Confidential EP AA APR2014 An Example of ME Attenuation Prior To Block RF ON Courtesy of William Maddox, MD, FHRS, Assistant Professor of Medicine, Georgia Regents University

© 2014 Boston Scientific Confidential EP AA APR2014 Another Example of ME Attenuation Prior To Block

© 2014 Boston Scientific Confidential EP AA APR2014 EGM-Guided Drag Lesion Catheter Drag Here

© 2014 Boston Scientific Confidential EP AA APR2014 Post-Ablation Gap Analysis

© 2014 Boston Scientific Confidential EP AA APR2014 Breakthrough on MiFi Not Evident on CBP Courtesy of William Maddox, MD, FHRS, Assistant Professor of Medicine, Georgia Regents University

© 2014 Boston Scientific Confidential EP AA APR2014 MiFi Gap Detection – Block Achieved