Journal article
Value of high-resolution mapping in optimizing cryoballoon ablation of atrial fibrillation.
- Conte G Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland. Electronic address: giulio.conte@cardiocentro.org.
- Soejima K Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan.
- de Asmundis C Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium.
- Chierchia GB Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium.
- Badini M Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
- Miwa Y Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan.
- Caputo ML Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
- Özkartal T Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
- Maffessanti F Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland.
- Sieira J Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium.
- Degreef Y Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium.
- Stroker E Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium.
- Regoli F Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
- Moccetti T Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
- Brugada P Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium.
- Auricchio A Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland; Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland.
- 2018-06-23
Published in:
- International journal of cardiology. - 2018
Ablation
Atrial fibrillation
Cryoballoon
High-resolution mapping
Pulmonary vein isolation
Adult
Aged
Atrial Fibrillation
Catheter Ablation
Cryosurgery
Echocardiography
Echocardiography, Transesophageal
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pulmonary Veins
English
BACKGROUND
Unrecognized incomplete pulmonary vein isolation (PVI), as opposed to post-PVI pulmonary vein reconnection, may be responsible for clinical recurrences of atrial fibrillation (AF). To date, no data are available on the use of high-resolution mapping (HRM) during cryoballoon (CB) ablation for AF as the index procedure. The aims of this study were: - to assess the value of using a HRM system during CB ablation procedures in terms of ability in acutely detecting incomplete CB lesions; - to compare the 8-pole circular mapping catheter (CMC, Achieve) and the 64-pole mini-basket catheter (Orion) with respect to pulmonary vein (PV) signals detection at baseline and after CB ablation; - to characterize the extension of the lesion produced by CB ablation by means of high-density voltage mapping.
METHODS
Consecutive patients with drug-resistant paroxysmal or early-persistent AF undergoing CB ablation as the index procedure, assisted by a HRM system, were retrospectively included in this study.
RESULTS
A total of 33 patients (25 males; mean age: 59 ± 18 years, 28 paroxysmal AF) were included. At baseline, CMC catheter revealed PV activity in 102 PVs (77%), while the Orion documented PV signals in all veins (100%). Failure of complete CB-PVI was more frequently revealed by atrial re-mapping with the Orion as compared to the Achieve catheter (24% vs 0%, p < 0.05). A repeat ablation was performed in 8 patients (24%). In 9% of cases, the Orion catheter detected far-field signals originating from the right atrium. Quantitative assessment of the created lesion revealed a significant reduction of the left atrial area having voltage >0.5 mV. A total of 29 patients (88%) remained free of symptomatic AF during a mean follow-up of 13.2 ± 3.7 months.
CONCLUSION
Atrial re-mapping after CB ablation by means of a HRM system improves the detection of areas of incomplete ablation, characterizes the extension of the cryo-ablated tissue and can identify abolishment of potential non-PVI related sources of AF.
Unrecognized incomplete pulmonary vein isolation (PVI), as opposed to post-PVI pulmonary vein reconnection, may be responsible for clinical recurrences of atrial fibrillation (AF). To date, no data are available on the use of high-resolution mapping (HRM) during cryoballoon (CB) ablation for AF as the index procedure. The aims of this study were: - to assess the value of using a HRM system during CB ablation procedures in terms of ability in acutely detecting incomplete CB lesions; - to compare the 8-pole circular mapping catheter (CMC, Achieve) and the 64-pole mini-basket catheter (Orion) with respect to pulmonary vein (PV) signals detection at baseline and after CB ablation; - to characterize the extension of the lesion produced by CB ablation by means of high-density voltage mapping.
METHODS
Consecutive patients with drug-resistant paroxysmal or early-persistent AF undergoing CB ablation as the index procedure, assisted by a HRM system, were retrospectively included in this study.
RESULTS
A total of 33 patients (25 males; mean age: 59 ± 18 years, 28 paroxysmal AF) were included. At baseline, CMC catheter revealed PV activity in 102 PVs (77%), while the Orion documented PV signals in all veins (100%). Failure of complete CB-PVI was more frequently revealed by atrial re-mapping with the Orion as compared to the Achieve catheter (24% vs 0%, p < 0.05). A repeat ablation was performed in 8 patients (24%). In 9% of cases, the Orion catheter detected far-field signals originating from the right atrium. Quantitative assessment of the created lesion revealed a significant reduction of the left atrial area having voltage >0.5 mV. A total of 29 patients (88%) remained free of symptomatic AF during a mean follow-up of 13.2 ± 3.7 months.
CONCLUSION
Atrial re-mapping after CB ablation by means of a HRM system improves the detection of areas of incomplete ablation, characterizes the extension of the cryo-ablated tissue and can identify abolishment of potential non-PVI related sources of AF.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ijcard.2018.05.135
- PMID 29929934
- Persistent URL
- https://sonar.ch/global/documents/279079
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