Background: With KODEX-EPD (EPD Solutions, Philips, Netherlands) a novel wide-band dielectric imaging system, was introduced providing real-time CT-like imaging during electrophysiology procedures. KODEX-EPD uses electrical fields to differentiate anatomical structures based on their dielectric properties. However, no data is yet available on whether these electrical fields are disturbed by metal structures such as cardiac implanted devices. 

Aim: We report on the feasibility and safety of KODEX-EPD during radiofrequency (RF) -based atrial fibrillation (AF) ablation in a 68-year-old male patient suffering from endstage heart failure, who had undergone interventional mitral valve repair via MitraClip and was supported by a left ventricular assist device (LVAD, Figure 1A). 

Case Report: Due to recurrent AF with worsening of right heart failure, RF-based AF-ablation guided by KODEX-EPD was performed in this patient. The procedure was performed under deep sedation. A coronary sinus-catheter was placed via the right femoral vein. After double transseptal puncture a 3D map of the left atrium (LA) and pulmonary veins (PVs) was created a spiral mapping catheter (Achieve, Medtronic, MN, USA) and KODEX-EPD. Point-by-point RF-based pulmonary vein isolation (PVI) was performed. 

High-resolution 3D-images of the LA and PVs were provided by KODEX-EPD in presence of 2 MitraClips as well as an LVAD-device without the need of additional pre-procedural imaging (Figure 1B). No map instabilities or map shifts were observed. Total procedure time and cumulative radiation dose was 120 minutes and 500 cGy/cm². RF-based AF-ablation was successfully performed with acute isolation of all PVs (Figure 1C). No periprocedural complication occurred. 

Conclusion: Catheter ablation of AF guided by the novel wide-band dielelectric imaging system appears to be feasible and safe in patients with cardiac implanted devices. Further analyses are desirable to confirm our findings.