Treatment of Patients after Pulmonary Vein Isolation in Persistent Atrial Fibrillation - Combined Use of a High-Density Map and Robotic Navigation

Abstract

Objectives and Background: Atrial fibrillation (AF) is still associated with higher recurrence rate. This is prospective study of Redo pulmonary vein isolation (PVI) combined with remote magnet navigation. We have done high density mapping and in retrospective Analysis we tried to find criteria for better Ablation success. Materials and Methods: 50 patients (male 36, female 14) with indication for Redo-PVI ware included. A 20 polig multielectrode catheter was used for mapping. Mapping data were collected bevor and after ablation and processed in terms of low-voltage areas bipolar (3 groups: 0.05-0.15 mV, 0.15-0.25 mV, 0.25-0.5 mV) and change in unipolar amplitude at the ablation lesions. The primary endpoint (symptom freedom at 12 months) was evidenced by follow-up examinations at 3, 6,9,12 months. Non-parametric statistical methods were used for variables with non-normal distributions. Trends in success rates were evaluated using the Kaplan-Meier methodology and compared using a log-ranking test. Results: In all analysed low-voltage bipolar groups occurs a change in the distribution after ablation in patients with AF. There are 3 parameters which related with endpoint: area of bipolar signals 0.05-0.15 mV (Me +32%, [95% CI: -10% to +167%], p<0.001), the unipolar amplitude at the applied ablation lesions (Me -0.45mV [95% CI: -0.15 to -1], p<0,001) and unipolar amplitude at the attached ablation lesions (lower amplitude was with recurrence associated, p=0.004). According to ROC analysis and logistic regression: failure to meet all 3 criteria accompanied with a 67% probability of symptomatic recurrence, if all 3 criteria are met, it is expected to have an approximately 81% success rate within the 12 months. Conclusion: Analysis of a high-density map including 3 criteria, help us to improve ablation success.