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Abstract

Microaxial flow devices (MFDs) provide hemodynamic support in patients with severe left ventricular systolic dysfunction but may introduce electromagnetic interference (EMI) during electroanatomic mapping, limiting the accuracy of magnetic-based localization systems. Although catheter ablation for atrial fibrillation in advanced heart failure is increasingly recognized as beneficial, limited data exist on mapping feasibility in patients supported by contemporary MFDs. Even less is known regarding left atrial flutter ablation in this setting.

We present a case illustrating the technical challenges and procedural feasibility of left atrial flutter ablation in a patient with advanced heart failure supported by an Impella 5.5 (Abiomed). Magnetic-based mapping was significantly impaired when the mapping catheter approached the Impella motor, resulting in EMI-related distortion. Transitioning to impedance-based mapping restored localization accuracy, enabling successful identification of the critical isthmus and subsequent termination of the arrhythmia. This case underscores the potential for EMI to disrupt magnetic-based mapping in mechanically supported patients and highlights impedance-based mapping as an effective strategy to maintain mapping fidelity during left atrial ablation.

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