TY - JOUR
T1 - Confirmation of pulmonary vein isolation with high-density mapping
T2 - Comparison to traditional workflows
AU - Porterfield, Christopher
AU - Gora, Peter J.
AU - Wystrach, Alexander
AU - Rossi, Pietro
AU - Rillo, Mariano
AU - Sebag, Frederic A.
AU - Giuggia, Marco
AU - Mantica, Massimo
AU - Dorszewski, Anja
AU - Eldadah, Zayd
AU - Volpicelli, Mario
AU - Bottoni, Nicola
AU - Jøns, Christian
AU - Hollis, Zachary T.
AU - Dekker, Lukas
AU - Mathew, Shibu
AU - Schmitt, Joern
AU - Nilsson, Kent
N1 - Publisher Copyright:
© 2020 CardioFront LLC. All rights reserved.
PY - 2020/5
Y1 - 2020/5
N2 - Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Yet tools and techniques used for confirmation of PVI vary greatly, and it is unclear whether the use of any particular combination of tools and techniques provides greater sensitivity for identifying gaps periprocedurally. It has been suggested that the use of a high-density mapping catheter, which enables simultaneous recording of adjacent bipolar EGMs in two directions, may provide improved sensitivity for gap identification. Anonymized, acute procedural data was prospectively collected in AF ablation cases utilizing various workflows for confirmation of PVI. Post-hoc analysis was performed to evaluate the incidence of gaps detected by different diagnostic catheter technologies, including a high-density mapping catheter and circular mapping catheters (CMCs), and common techniques such as pacing the ablation lines. A total of 139 cases were included across three subgroup analyses: 99 cases were included in an indirect comparison of three mapping catheter technologies, revealing gaps in 36.7%, 38.9%, and 81.8% of cases utilizing a 10-pole CMC, 20-pole CMC, and a high-density mapping catheter, respectively; a direct comparison of diagnostic catheter technologies in 18 cryoballoon ablation cases revealed residual gaps in 22.2% of patients identified by high-density mapping which were missed previously with the use of a 3.3F CMC; in 22 cases utilizing a technique of pacing the ablation lines, high-density mapping identified residual gaps in 68.2% of patients. This proof of concept analysis demonstrated that the use of a high-density catheter which records orthogonal bipoles simultaneously, appears to improve acute detection of gaps in PVI lines relative to other commonly utilized techniques and technologies. The long-term impact of ablating these concealed gaps remains unclear. Further study, including direct comparison of diagnostic catheter technologies in a randomized setting with long-term followup, is warranted.
AB - Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Yet tools and techniques used for confirmation of PVI vary greatly, and it is unclear whether the use of any particular combination of tools and techniques provides greater sensitivity for identifying gaps periprocedurally. It has been suggested that the use of a high-density mapping catheter, which enables simultaneous recording of adjacent bipolar EGMs in two directions, may provide improved sensitivity for gap identification. Anonymized, acute procedural data was prospectively collected in AF ablation cases utilizing various workflows for confirmation of PVI. Post-hoc analysis was performed to evaluate the incidence of gaps detected by different diagnostic catheter technologies, including a high-density mapping catheter and circular mapping catheters (CMCs), and common techniques such as pacing the ablation lines. A total of 139 cases were included across three subgroup analyses: 99 cases were included in an indirect comparison of three mapping catheter technologies, revealing gaps in 36.7%, 38.9%, and 81.8% of cases utilizing a 10-pole CMC, 20-pole CMC, and a high-density mapping catheter, respectively; a direct comparison of diagnostic catheter technologies in 18 cryoballoon ablation cases revealed residual gaps in 22.2% of patients identified by high-density mapping which were missed previously with the use of a 3.3F CMC; in 22 cases utilizing a technique of pacing the ablation lines, high-density mapping identified residual gaps in 68.2% of patients. This proof of concept analysis demonstrated that the use of a high-density catheter which records orthogonal bipoles simultaneously, appears to improve acute detection of gaps in PVI lines relative to other commonly utilized techniques and technologies. The long-term impact of ablating these concealed gaps remains unclear. Further study, including direct comparison of diagnostic catheter technologies in a randomized setting with long-term followup, is warranted.
KW - Atrial Fibrillation
KW - High density mapping
KW - Pulmonary vein isolation (PVI)
UR - http://www.scopus.com/inward/record.url?scp=85094820817&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85094820817&partnerID=8YFLogxK
U2 - 10.4022/JAFIB.2361
DO - 10.4022/JAFIB.2361
M3 - Article
AN - SCOPUS:85094820817
SN - 1941-6911
VL - 12
JO - Journal of Atrial Fibrillation
JF - Journal of Atrial Fibrillation
IS - 6
ER -