Affera Foundations Flashcards

Vocabulary flashcards generated from the Affera Foundations review materials.

Single Mapped Point Data

The anatomical location of acquired data, electrogram morphology, local voltage within a specific area, and relative activation timing compared to reference locations.

Cycle Length (CL) Filter Function

A mapping filter that restricts displayed data to a single target tachycardia cycle length, excluding ectopic or non-target beats.

Voltage Mapping Inferences

Provides clinical insights into peak-to-peak electrogram voltage amplitude and assesses the viability and health of cardiac tissue.

Classification of Map Types (Grey, Rainbow CL-timed, Rainbow MV)

Map A is Anatomical (grey only), Map B is Activation (rainbow with cycle length timing), and Map C is Voltage (rainbow with millivolts on the color bar).

Thermal Threshold for Cell Death

The specific temperature threshold required to induce irreversible myocardial cell death, which is $50^\circ\text{C}$.

Stable Reference Requirement in Mapping

Necessary because every acquired mapping point is assigned a local activation time calculated relative to reference time $0$.

Good Reference Signal Characteristics

Consistent beat-to-beat electrogram morphology, a clean signal free of noise, and catheter placement in an anatomically stable location.

Patient Patch Placement Best Practices

Ensuring skin is clean, dry, and shaven to maximize conductivity, while assigning highest placement priority to defibrillation patches.

Window of Interest (WOI) Setup Considerations

Evaluating whether the underlying rhythm is focal or reentrant, determining the proportion of the cardiac cycle to encompass, and identifying the mapped chamber.

Pacing Maneuvers Purpose in EP Studies

Diagnostic pacing techniques used to test the cardiac conduction system, evaluate arrhythmia circuits, and actively induce targeted tachycardias.

Impedance-Only Mapping Advantages over Magnetic-Only Mapping

Offers greater cost-effectiveness, reduced vulnerability to patient movement shifts, and compatibility with any catheter to streamline workflow.

Factors Influencing Voltage Threshold Variability

Signal processing algorithms, inter-electrode spacing, native chamber-specific tissue voltage variation, and catheter-tissue contact quality.

Ideal Fluoroscopic View to Cut Out the Valve Plane

The Right Anterior Oblique (RAO) projection view.

Fractionated Potentials Clinical Significance

Intracardiac electrograms indicating regions of slow conduction within diseased cardiac substrate.

Cardiac Structure Nearest to SA Node

Right Superior Pulmonary Vein (RSPV).

Causes of Low-Voltage Regions on Maps

Injured or scarred cardiac tissue, healthy non-myocardial venous tissue, or inadequate electrode-tissue contact.

Typical Atrial Voltage Mapping Settings

Dense scar threshold set at $0.1\,\text{mV}$ and healthy tissue threshold set at $0.5\,\text{mV}$.

Coronary Sinus (CS) Location on Tricuspid Valve Clock Face

The $4\text{ o'clock}$ position.

Ideal Fluoroscopic View to Look Down the Valve Plane

The Left Anterior Oblique (LAO) projection view.

Editable Mapping Artifacts

Data points collected during rapid catheter movement, anatomical pouching, or patient coughing episodes.

Primary Interatrial Conduction Route

Electrical conduction traveling from the right atrium to the left atrium across Bachmann's bundle.

His Bundle Position on Tricuspid Valve Clock Face

The $2\text{ o'clock}$ position.

Left Atrium (LA) Anatomical Clarification Edits

Trimming pulmonary vein (PV) extensions, cutting the mitral valve (MV) annulus, and clearly delineating the Coumadin ridge.

Right Atrium (RA) Anatomical Clarification Edits

Trimming superior and inferior vena cava (SVC/IVC) extensions, cutting the tricuspid annulus, and delineating the right atrial appendage (RAA).

QS Pattern Significance on MAP Electrogram

An electrogram displaying two fully negative deflections, indicating that the electrical activation wavefront originates directly from that mapped point.

Arrhythmia Differentiation Characteristics

Coronary sinus (CS) activation sequence, surface P-wave morphology, tachycardia cycle length (TCL), and warm-up or cool-down behavior.

Primary Purpose of Window of Interest (WOI)

Frames a single beat of tachycardia to allow for the precise collection and display of local activation timing for that rhythm beat.

Critical Anatomical Structures Near Superior Vena Cava (SVC)

Sinoatrial Node (SAN) and the Phrenic Nerve.

Post-Therapy Acute Success Verification Protocol

Attempting re-induction using intravenous isoproterenol administration and during washout using the exact pacing protocol that originally induced the arrhythmia.

Relationship Between Atrial Tachycardia (AT) Rate and AH/PR Intervals

False; AH and PR intervals are not inversely related to AT rate (faster rates do not shorten AH/PR intervals).

Crista Terminalis Arrhythmogenicity Rationale

Represents an anatomical junction connecting trabeculated muscle to smooth cardiac tissue, making it a frequent source for focal atrial tachycardias.

Key Pre-Procedure Diagnostic Data for Atrial Tachycardia

Documented 12-lead EKG from an emergency room visit, CT imaging to evaluate for left atrial appendage (LAA) thrombus, and patient symptomatic history.

Eccentric CS Activation Pattern Definition

Activation sequence where the distal CS ($\text{CS}_d$) is activated first and the proximal CS ($\text{CS}_p$) is activated last.

Required Mapping Reference During Atrial Flutter

An atrial reference signal.

CTI Ablation Minor Concern (Not Critical)

The location of the Sinoatrial (SA) node is not a major concern during CTI ablation.

Respiration Gating Map Impact Statement

False; respiration gating actively filters point acquisition based on the respiratory cycle, directly impacting geometry and map quality beyond simple patient monitoring.

Caliper Placement Strategy for Atrial Flutter WOI

Positioning calipers to encompass exactly one full P-wave duration.

Essential Information Required Before EP Case Initiation

Detailed patient clinical history and relevant cardiac imaging studies.

Rationale for Ablating Cavotricuspid Isthmus (CTI) in RA Flutter

Serves as the shortest anatomical corridor to ablate when creating a line of block between two non-conducting structures in the right atrium.

Entrainment Circuit Confirmation Threshold ($\text{PPI} - \text{TCL}$)

A post-pacing interval minus tachycardia cycle length difference of less than $30\,\text{ms}$ ($\text{PPI} - \text{TCL} < 30\,\text{ms}$).

Signal Indicating CTI Line Block Leak

Detection of a double potential signal along the ablation line during pacing.

Characteristic NOT Associated with Atrial Flutter

Irregular R-R intervals (atrial flutter typically exhibits regular R-R intervals or fixed block conduction).

Standard Stable Reference Catheter for General EP Studies

Coronary Sinus (CS) catheter.

Electrocardiographic Sign of Inverted P-Waves in Inferior Leads (II, III, aVF) with Positive V1

Activation wavefront moving superiorly away from the inferior wall and anteriorly toward V1, indicating counterclockwise atrial flutter macro-reentry.

Preferred Fluoroscopic Projection for Visualizing LA Roving Mapping Catheter

Posterior-Anterior (PA) projection view.

Inclusion of Ventricular EGM Signals in Atrial Maps Policy

False; ventricular EGM signals must be excluded because accurate atrial activation timing requires uncorrupted atrial signals.

Protocol for Low-Voltage Color Signals in Veins Post-PVI

Conduct differential pacing maneuvers to check for far-field signals, evaluate signals to rule out local ectopy, and verify entrance and exit block.

Placement Verification Cues for Coronary Sinus Catheter

Intracardiac electrogram morphology, fluoroscopic cannulation postero-septally in the RA, and LAO view showing catheter wrapping around the LA along the mitral valve annulus.

Optimal Mapping Reference During Atrial Fibrillation (AF)

A stable ventricular reference signal.

Anatomic Structures Tagged During Pulmonary Vein Isolation (PVI)

Esophagus, Phrenic Nerve, and Ganglionic Plexi.

Preferred Reference Selection for Paced Mapping

The pacing spike.

Indication for Disabling Cycle Length (CL) Filter

When creating an Atrial Fibrillation (AF) map due to the chaotic and variable cycle length of the arrhythmia.

Pacing Spike Inclusion in Voltage Maps Policy

No; pacing spikes introduce signal artifacts that falsely distort measured peak-to-peak voltage.

Suitability of Activation Mapping in Atrial Fibrillation

No; AF lacks a repeatable, organized activation sequence, making activation mapping unsuitable.

Rationale for Preferring Paced Maps over Maps in Normal Sinus Rhythm (NSR)

Enables faster map acquisition and provides a highly stable, consistent reference signal.

LAT Map Converging Color Meaning

Represents a wavefront collision where two opposing activation fronts meet.

Line Critical Path Abandonment Policy Upon CS Activation Shift

False; a change in CS activation timing during line ablation indicates modification of the circuit or block, not that the line is outside the critical path.

Clinical Significance of 'Early Meets Late' Area on LAT Map

Does not inherently indicate an ablation target; it is a color display artifact resulting from color scale wraparound on a continuous circuit.

Diagnostic Methods to Rule Out RA Origin in Left Atrial Flutter

Entrainment pacing maneuvers, 3D anatomical mapping, and surface ECG lead analysis.

Surface ECG Characteristics of Classic Atrial Flutter

Sawtooth flutter waves and a ratio showing more atrial deflections than ventricular deflections (A > V).

Pre-Procedure Clinical Data Required for Atypical Atrial Flutter

Previous cardiac surgical and ablation history, documented arrhythmia recordings, and baseline clinical rhythm status.

Activation Timing Behavior when Approaching a Blocked Line

Progressive conduction delay occurs, causing activation timing to become significantly longer as the catheter nears the line.

Low Voltage Area Arrhythmogenicity and Ablation Policy

No; low voltage areas represent tissue scar or uncoupled myocardium, but not all low voltage regions harbor active arrhythmia circuits or require ablation.

Reliability of Tachycardia Cycle Length (TCL) Alone to Differentiate Reentrant vs Focal Tachycardias

No; TCL alone cannot reliably differentiate focal from reentrant mechanisms without additional maneuvers like entrainment.

Proximal-to-Distal CS Activation as Definitive Indicator of RA Flutter

No; proximal-to-distal CS activation indicates a right-to-left or septal activation sequence, which can occur in both RA and LA arrhythmias.

Electrogram Characteristics to Avoid for Mapping Reference

Signal noise, far-field electrogram components, and multi-peaked fractionated signals.

Affera System Impedance Reference Configuration

Body Surface Reference composed of limb leads and V1, and Intracardiac Reference designated by the electrode plugged into position #1 of the intracardiac pin block.

Primary Port Automatic Catheter Recognition Policy

True; catheters connected through the primary port for magnetic mapping are automatically recognized as the primary mapping catheter in system settings.

Significance of Blue or Red Impedance Field Grid Cross

Indicates reduced tracking confidence and potential impedance spatial mapping distortion.

Essential Surface Leads for Affera Surface Reference

True; the limb leads (RA, LA, RL, LL) and lead V1 serve as the essential surface reference for system position tracking.

12-Lead Signal Hardware Pathway

Patient $\rightarrow$ Affera System $\rightarrow$ EP Recording System.

Superior-Inferior Patch Placement Guidelines

Placed below the anterior patch at the hip level.

Patch Quality Status Key Indicators

Good quality, Poor quality, and No Connection.

Affera Mapping Patch Quantity (Prism 2 Software)

Exactly $6$ mapping patches are attached to the patient.

Left and Right Lateral Patch Alignment

Positioned opposingly in approximately the same horizontal anatomical plane across the torso.

Secondary Catheter Setup Steps After Library Addition

Identify the starting pin position and check the 'Visible' box to enable visualization and map data collection.

Mapping Point Projection Distance Function Definition

False; projection distance defines how far off-surface points are projected onto the anatomical mesh, not whether they are excluded from display.

Workstation Ethernet Port Connection Target

Connects the Radiofrequency Generator (RFG / Hexagen) to the Catheter Interface Unit (CIU / Hexamap).

Lead Troubleshooting Sequence for Noisy ECG Leads I and III

Inspect and re-prep the Left Arm (LA) electrode first, as it is common to both lead I and lead III.

Core Benefits of Impedance-Based Tracking Systems

Provides workflow flexibility and enables tracking and mapping capabilities across all standard EP catheters.

Method to Change Active Data Collection Mapping Catheter

Select the target catheter using the drop-down menu adjacent to the collection button on the primary screen.

Superior Mapping Patch Placement Location

Positioned above the posterior patch near the trapezius muscle region.

Location of Magnetic Localization Sensors

Housed directly within the snap connector clip of the localization patch adapter.

Generator Link Cable Port Orientation on CIU

True; the generator link cable port on the CIU is positioned directly beneath the corresponding port on the Pulsed Field Generator (PFG).

Sphere-9 Extension Cable Port Configuration Status

False; the port was modified and shifted leftward to serve as the primary magnetic plug interface.

Sphere-9 Lattice Energy Delivery Sequence

Energy is delivered simultaneously through the entire lattice structure and sequentially to the individual mini-electrodes.

Sphere-9 Electrode Count

Consists of $9$ mini-electrodes distributed across the lattice.

Radiofrequency Modulation Method on Sphere-9

Delivery is temperature-controlled and current-limited to prevent overheating while optimizing lesion formation.

Sphere-9 Pulsed Field Waveform Composition

Delivers a unipolar, biphasic electrical energy waveform.

Sphere-9 Lattice Diameter

Expandable lattice structure measuring $9\,\text{mm}$ in diameter.

Function of Central Reference Electrode on Sphere-9

Serves as a close unipolar electrogram reference located within the catheter tip to reduce far-field signal interference.

Sphere-9 Irrigation Port Placement

Positioned centrally along the catheter shaft inside the lattice structure.

Pulsed Field (PF) Lesion Dimensions and Duration on Sphere-9

Creates lesions measuring $17.2\,\text{mm}$ wide by $5.6\,\text{mm}$ deep with a standard delivery duration of $4\,\text{s}$.

Radiofrequency (RF) Lesion Dimensions and Duration on Sphere-9

Creates lesions measuring $18.7\,\text{mm}$ wide by $4.8\,\text{mm}$ deep with a standard delivery duration of $5\,\text{s}$.

Sheath Compatibility Options for Sphere-9

Compatible with an $8\,\text{Fr}$ straight sheath or an $8.5\,\text{Fr}$ deflectable sheath.

Incompatible Sheath Warning for Sphere-9

$13\,\text{Fr}$ Agilis sheaths must NOT be used because they cause lattice mushrooming and deformation.

Sphere-9 Catheter Shaft French Size

Standard $8\,\text{Fr}$ shaft outer diameter.

Sphere-9 Deflection Curves Configuration

Features $2$ bidirectional curves: D-curve (blue marker, pull left) and F-curve (orange marker, pull right).

Cable Interfacing Sphere-9 to Affera Mapping System

Connected via the dedicated Catheter Extension Cable.

Purpose of Red Markers on Sphere-9 Shaft

Enclose embedded magnetic sensors used for 3D location tracking and geometry scaling.