Role of high-density voltage map guiding parosysmal atrial fibrillation ablation

Abstract

Abstract Background High-density mapping of the pulmonary vein antra has been demonstrated to improve the detection of conduction gaps in wide antral catheter ablation (WACA) approach for the treatment of paroxysmal atrial fibrillation (AF). Purpose We aimed to compare the AF recurrencies in patients treated with WACA for pulmonary veins isolation (PVI) guided by high-density bipolar voltage map (BVM) vs WACA guided by a standard 20-pole circumferential mapping catheter (CMC-20). Methods This prospective study included patients scheduled for AF ablation in a single center. In group A (85 patients) PVI was achieved with a conventional approach using CMC-20; in group B (96 patients) high density BVM was acquired by sequential multielectrode mapping through Pentaray Catheter (Biosense Webster). More than 1000 voltage points per map were acquired. Acute PVI was defined as an entrance and exit block after ≥ 20 min waiting period. In both groups WACA was perfomed using a contact force sensing catheter targeting an interlesion distance ≤6 mm and ablation index ≥400 at posterior wall and ≥550 at anterior wall. The primary endpoint was the AF recurrencies in the two groups. Results A total of 181 patients were included (mean age 64.9±10.6 years, 33.1% female): in 85 patients AF ablation was guided by CMC-20, in 96 patients AF ablation was guided by BVM; WACA PVI was achieved in all patients. There were no significant differences in the clinical characteristics of the two groups (table 1). At 12-month follow-up, AF recurrencies were significantly lower in the BVM group compared with CMC-20 group [11/96 (11.4%) vs 19/85 (22.3%) respectively, p=0.01]. Conclusions High-density BVM might increase success rate of AF ablation compared with a conventional 20-pole circumferential mapping approach.