Abstract
Aims: The CARTOFINDER module allows for simultaneous and automated detection of repetitive focal and rotational activations in patients with atrial arrhythmias. This study aimed to validate the CARTOFINDER algorithm for the detection of potential drivers for atrial fibrillation (AF) and to access their potential impact on individual arrhythmia substrates. Methods: Fifty consecutive patients underwent AF ablation for persistent AF (PERS), using a 3D-mapping system with the integrated CARTOFINDER module. Regions of interest (ROIs) were identified before and after ablation, and their spatial and temporal relationship was correlated with areas of fibrosis. Results: Procedural success was achieved in all patients and 42% received ablation beyond pulmonary vein isolation (PVI). AF termination was observed in 6 patients (12%). The mean procedure duration was 134 ± 29 min. ROIs were revealed in all patients (mean n = 77 ± 52) and there was no statistical evidence for a predilection site. There was no significant anatomical correlation between ROIs and bipolar low voltage. Remapping confirmed the elimination of ROIs in relation to the individual ablation site, a limited reproducibility of rotational ROIs and persistent focal activity over time in some anatomical segments. ROIs were not a predictor for AF recurrence during following ablation. Conclusions: CARTOFINDER mapping can be integrated into a routine workflow for AF ablation. ROIs could be discriminated in all patients and an ablation effect was observed in some patients, whereas persistent activity was found in certain anatomical segments, even after ablation. ROIs might be an additional ablation target when we are able to understand the individual substrate.
Highlights
Licensee MDPI, Basel, Switzerland.Catheter ablation for persistent atrial fibrillation (AF) is challenging and associated with limited outcomes [1]
AF was defined as persistent if AF was continuously sustained beyond 7 days, including episodes terminated by cardioversion after ≥7 days [1]
A total of 50 patients with persistent AF (PERS) underwent de novo AF ablation in conjunction with CARTOFINDER mapping for Regions of interest (ROIs)
Summary
Licensee MDPI, Basel, Switzerland.Catheter ablation for persistent atrial fibrillation (AF) is challenging and associated with limited outcomes [1]. Advances in mapping technologies have allowed for more detailed approaches, including panoramic and body-surface mapping for potential individual focal AF driver or rotational activity [5,6,7,8]. The elimination of these phenomena has been linked to higher ablation success [9,10]. On the basis of this technology, focal and rotation activity can be revealed during sustained atrial arrhythmias and directly visualized inside the electroanatomical mapping system to guide ablation
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