Abstract 11159: Assessment of Atrial Cardiomyopathy by High-Density Mapping Can Guide Additional Procedures in AF Ablation

Abstract

Background: The efficacy of catheter ablation (CA) for atrial fibrillation (AF) has been lower in persistent AF (PeAF). Additional ablation strategies beyond pulmonary vein isolation (PVI) are not routinely recommended in PeAF because their efficacy is not established yet. The clinical AF patterns could not expect the degree of atrial abnormal voltage area (AVA). The inability to discriminate significant atrial cardiomyopathy may lead to diverse ablation outcomes beyond PVI in PeAF. Objectives: The objective of this study was to find out how much proportion of AVA can predict higher AF recurrence after PVI. Methods: We enrolled the consecutive 49 patients who underwent CA of AF. LA was mapped with Pentaray® catheter (2-6-2 spacing) during mid-CS pacing (600msec) using the CONFIDENCE Module. The peak-to-peak bipolar voltage was obtained using only 2mm spacing electrodes. The AVA was defined when the bipolar voltage was < 1.5mV, which is known to be normal in LA. After excluding PVs, appendage, and mitral valve region, the proportion of AVA was calculated by the Carto 3 mapping system. The ablation strategy was PVI only regardless of the AF pattern & degree of AVA. Results: The mean age was 58.1 ± 7.7 years, and 73.5% were male. The average mapping points were 3557.5 ± 760.9. The average proportion of AVA was 31.4 ± 15.3%. The paroxysmal AF (PAF) patients were 71.4%, and the mean AVA between PAF and PeAF was significantly different (28.7 ± 15.5 vs. 38.2 ± 12.7, p=0.049). The mean follow-up duration was 265.8 ± 150.4 days. Atrial tachyarrhythmia recurred in 35.7%. In receiver-operating curve analysis, the proportion of AVA of 33.4% predicts AF recurrence regardless of AF type with a sensitivity of 75% and specificity of 78.8% (AUC 0.864, P<0.001). Conclusion: More than one-third of AVA assessed by high-density mapping could be used as a predictor of the recurrence of AF after CA, which may guide the consideration of additional ablation. However, a randomized controlled trial is warranted.