Abstract
Introduction: Catheter ablation (CA) has been proven to be the most effective treatment strategy in paroxysmal atrial fibrillation (AF), however, it remains challenging due to suboptimal success rates in persistent AF. Existing mapping technologies cannot reliably distinguish active sources in this patient population. Recently, a novel mapping system (electrographic flow mapping, EGF) was developed, using computer vision and optical flow smoothing algorithms to detect and quantify patterns of electrical wavefront propagation in the atria. Hypothesis: We hypothesised that EGF mapping is superior to classical three-dimensional electroanatomic mapping (CARTO) in one-year outcomes of CA for persistent AF. We assessed procedural safety and efficiency too. Methods: The study group included patients with persistent AF undergoing CA using EGF combined with CARTO (group1). Data of group 1 patients were compared with data from pulmonary vein isolation (PVI)-only procedures (group 2) and PVI plus additional empiric substrate ablation procedures (group 3) using CARTO. 12-months outcome as freedom from AF and atrial tachycardia/atrial flutter (AT/AFL), procedural safety and efficiency were analysed too. Results: A total number of 70 consecutive patients were included (mean age 63.9±7.8 years). Thirty-nine patients were included in group 1, 16 patients in group 2) and 15 patients in group 3). Patients in group 1 had fewer AF recurrences compared to group 2 and group 3 at 12 months (23.1% vs. 62.5% vs. 46.7%, p=0.01). There were no differences in AT/AFL recurrence between the study groups (12.8% vs. 18.8% vs. 16.7%, p=0.84). Procedure-related complications were documented in none of the study groups. Procedure times were longer in group 1 (187.2±51.6 vs. 136.3±55.4 vs. 139.6±48.6 min, p<0.01). There were no differences in fluoroscopy use (275.8±172.8 vs. 321.4±254.8 vs. 212.3±127.8 mGy, p=0.27), RF application number (p=0.24) and application duration (p=0.77) between the study groups. Conclusions: Our data suggest that patients treated with combined EGF and CARTO mapping-based CA have less AF recurrences at one-year. The procedure is safe and seems to be a promising treatment alternative for this complex group of patients.
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