© 2014 Boston Scientific Confidential EP-242101-AA APR2014 IntellaTip MiFi ™ XP Ablation Catheter...

© 2014 Boston Scientific Confidential EP-242101-AA APR2014

IntellaTip MiFi™ XP Ablation Catheter

Atrial Flutter Playbook

Information for the use in countries with applicable Health Authority product registrations.


The Power of the Mini-electrodes

Using IntellaTip MiFi™ XP multi-sense technology for Atrial Flutter cases

Entrainment & Pacing Maneuvers

CTI Identification

HIS Recording Contact Assessment

Real-Time Ablation Feedback

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.


HIS Recording


MiFi vs. Common Bipoles – His?


Another HIS Recording

Courtesy of University of Alabama Birmingham


Entrainment and Pacing Maneuvers


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;94:398-406

An Oversimplified Explanation of Entrainment

Circuit

PacingSite

Timing is measured on the pacing channel. Therefore, the pacing channel must recover at a timing interval less than the Tachycardia Cycle Length! (TCL)


Pacing from the ABL D

PPI? TCL? Returning to

Baseline



Pacing from MiFi pair 1-2

Final Pacing Impulse

Returning to Baseline

**No Saturation on ABL D



Traditional Entrainment From Ablation Distal @ 5mA – Saturation on CBP



Traditional Entrainment From Ablation Distal @ 2mA – No Capture



Entrainment From Mini 1-2 @ 2mA – Capture



EntrainmentFrom Mini 1-2 @ 1mA – Capture



CTI Identification


MiFi Catheter on CTI?

Courtesy of William Maddox, MD, FHRS, Assistant Professor of Medicine, Georgia Regents University


CTI?



CTI


Fluoro Image Comparison

Common Bipole CTI Placement MiFi CTI Placement



Catheter Positioning Based on MiFi

V Pulled back to A AV Junction


True CTI

Another Example of CTI Identification

Abl:ON


Contact Assessment


Perpendicular Contact?



MiFi Good Contact – ME 1 Touching



More Parallel Contact – SVC pullback

Parallel Tissue Contact with ME 1 in Primary Contact


Real-Time Ablation Feedback


EGM Attenuation – CBP vs. MEs



An Example of ME Attenuation Prior To Block

RF ON



Another Example of ME Attenuation Prior To Block


EGM-Guided Drag Lesion

Catheter Drag Here


Post-Ablation Gap Analysis


Breakthrough on MiFi Not Evident on CBP



MiFi Gap Detection – Block Achieved

© 2014 Boston Scientific Confidential EP-242101-AA APR2014 IntellaTip MiFi ™ XP Ablation Catheter...

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