Background: Cardiac mapping and tracking of catheters have become indispensable for ablation of many cardiac arrhythmias.
Objective: We describe our initial experience with the novel KODEX - EPD system (EPD Solutions, a Philips company, The Netherlands) to image the cardiac anatomy and track application of RF energy.
Methods: Patients are prospectively enrolled since November 27, 2019 after informed consent to undergo RF catheter ablation with ethics committee approval. A 3-D anatomical shell of the cardiac chambers is determined with a roving catheter emitting broadband radiowaves in close proximity to the wall. Voltage maps can be obtained by contact-based mapping at desired areas. Ablation is carried out according to standard of care. Both 3-D as well as flattened 3-D PANO view imaging of the flat surface of the ablation chamber is used to visualize the ablation target and guide RF applications until the desired outcome is achieved.
Results: Since November 27th 2019, 5 patients have been treated for SVT using the KODEX - EPD system, 3 of them with typical RA flutter, 1 with AVNRT, and 1 with paroxysmal AF. The ablation target was the CTI for RA flutter, slow pathway for AVNRT, and RF PVI for AF. Anatomical shells and (partial) voltage maps were successfully constructed in all patients. All ablation targets were successfully treated resulting in bidirectional CTI block in 3 patients, non-inducibility of AVNRT in 1 patient, and isolation of all pulmonary veins in 1 patient. The PANO view was used in all patients to provide a flat surface projection of the ablation target and guide appropriate RF ablation. In the patient with AVNRT, zero fluoroscopy was used to guide 3 catheters from the groin to the heart under continuous KODEX - EPD imaging, and then perform a complete anatomical and voltage map before ablation of the slow pathway. Patients are included on a weekly basis so that many more cases will be available in May 2020 for final presentation.
Conclusion: The KODEX - EPD system provides a completely novel 3-D imaging system using broadband radiowaves and electromagnetic mapping to build anatomical shells to guide successful SVT ablation. Future versions will include wall thickness and lesion characteristic modality to guide transmural ablation for arrhythmias.