Initial experience of the High-Density Grid catheter in patients undergoing catheter ablation for atrial fibrillation.
Atrial fibrillation
Catheter ablation
Electrograms
Pulmonary veins
Journal
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
ISSN: 1572-8595
Titre abrégé: J Interv Card Electrophysiol
Pays: Netherlands
ID NLM: 9708966
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
received:
17
07
2020
accepted:
24
01
2021
pubmed:
28
2
2021
medline:
8
4
2022
entrez:
27
2
2021
Statut:
ppublish
Résumé
A significant proportion of patients undergoing catheter ablation for atrial fibrillation (AF) experience arrhythmia recurrence. This is mostly due to pulmonary vein reconnection (PVR). Whether mapping using High-Density Wave (HDW) technology is superior to standard bipolar (SB) configuration at detecting PVR is unknown. We aimed to evaluate the efficacy of HDW technology compared to SB mapping in identifying PVR. High-Density (HD) multipolar Grid catheters were used to create left atrial geometries and voltage maps in 36 patients undergoing catheter ablation for AF (either due to recurrence of an atrial arrhythmia from previous AF ablation or de novo AF ablation). Nineteen SB maps were also created and compared. Ablation was performed until pulmonary vein isolation was achieved. Median time of mapping with HDW was 22.3 [IQR: 8.2] min. The number of points collected with HDW (13299.6±1362.8 vs 6952.8±841.9, p<0.001) and used (2337.3±158.0 vs 1727.5±163.8, p<0.001) was significantly higher compared to SB. Moreover, HDW was able to identify more sleeves (16 for right and 8 for left veins), where these were confirmed electrically silent by SB, with significantly increased PVR sleeve size as identified by HDW (p<0.001 for both right and left veins). Importantly, with the use of HDW, the ablation strategy changed in 23 patients (64% of targeted veins) with a significantly increased number of lesions required as compared to SB for right (p=0.005) and left veins (p=0.003). HDW technology is superior to SB in detecting pulmonary vein reconnections. This could potentially result into a significant change in ablation strategy and possibly to increased success rate following pulmonary vein isolation.
Identifiants
pubmed: 33638777
doi: 10.1007/s10840-021-00950-y
pii: 10.1007/s10840-021-00950-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
259-266Informations de copyright
© 2021. Springer Science+Business Media, LLC, part of Springer Nature.
Références
Nery PB, Belliveau D, Nair GM, Bernick J, Redpath CJ, Szczotka A, et al. Relationship Between Pulmonary Vein Reconnection and Atrial Fibrillation Recurrence: A Systematic Review and Meta-Analysis. JACC Clin Electrophysiol. 2016;2:474–83.
doi: 10.1016/j.jacep.2016.02.003
Morillo CA, Verma A, Connolly SJ, Kuck KH, Nair GM, Champagne J, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA. 2014;311:692–700.
doi: 10.1001/jama.2014.467
Lin D, Santangeli P, Zado ES, et al. Electrophysiologic findings and long-term outcomes in patients undergoing third or more catheter ablation procedures for atrial fibrillation. J Cardiovasc Electrophysiol. 2015;26:371–7.
doi: 10.1111/jce.12603
Kuck KH, Hoffmann BA, Ernst S, et al. Impact of Complete Versus Incomplete Circumferential Lines Around the Pulmonary Veins During Catheter Ablation of Paroxysmal Atrial Fibrillation: Results From the Gap-Atrial Fibrillation-German Atrial Fibrillation Competence Network 1 Trial. Circ Arrhythm Electrophysiol. 2016;9:e003337.
doi: 10.1161/CIRCEP.115.003337
Nanthakumar K, Plumb VJ, Epstein AE, Veenhuyzen GD, Link D, Kay GN. Resumption of electrical conduction in previously isolated pulmonary veins: rationale for a different strategy? Circulation. 2004;109:1226–9.
doi: 10.1161/01.CIR.0000121423.78120.49
Hussein A, Das M, Riva S, et al. Use of Ablation Index-Guided Ablation Results in High Rates of Durable Pulmonary Vein Isolation and Freedom From Arrhythmia in Persistent Atrial Fibrillation Patients. Circ Arrhythm Electrophysiol. 2018;11:e006576.
doi: 10.1161/CIRCEP.118.006576
Hutchinson MD, Garcia FC, Mandel JE, Elkassabany N, Zado ES, Riley MP, et al. Efforts to enhance catheter stability improve atrial fibrillation ablation outcome. Heart Rhythm. 2013;10:347–53.
doi: 10.1016/j.hrthm.2012.10.044
Park CI, Lehrmann H, Keyl C, et al. Mechanisms of pulmonary vein reconnection after radiofrequency ablation of atrial fibrillation: the deterministic role of contact force and interlesion distance. J Cardiovasc Electrophysiol. 2014;25:701–8.
doi: 10.1111/jce.12396
Piorkowski C, Eitel C, Rolf S, Bode K, Sommer P, Gaspar T, et al. Steerable versus non steerable sheath technology in atrial fibrillation ablation: a prospective, randomized study. Circ Arrhythm Electrophysiol. 2011;4:157–65.
doi: 10.1161/CIRCEP.110.957761
Chen S, Meng W, Sheng He D, et al. Blocking the pulmonary vein to left atrium conduction in addition to the entrance block enhances clinical efficacy in atrial fibrillation ablation. Pacing Clin Electrophysiol. 2012;35:524–31.
doi: 10.1111/j.1540-8159.2012.03343.x
Anter E, Contreras-Valdes FM, Shvilkin A, Tschabrunn CM, Josephson ME. Acute pulmonary vein reconnection is a predictor of atrial fibrillation recurrence following pulmonary vein isolation. J Interv Card Electrophysiol. 2014;39:225–32.
doi: 10.1007/s10840-013-9864-9
Porta-Sánchez A, Magtibay K, Nayyar S, Bhaskaran A, Lai PFH, Massé S, et al. Omnipolarity applied to equi-spaced electrode array for ventricular tachycardia substrate mapping. Europace. 2019;21:813–21.
doi: 10.1093/europace/euy304
Kanamori N, Kato T, Sakagami S, Saeki T, Kato C, Kawai K, et al. Optimal lesion size index to prevent conduction gap during pulmonary vein isolation. J Cardiovasc Electrophysiol. 2018;29:1616–23.
doi: 10.1111/jce.13727
Whitaker J, Fish J, Harrison J, et al. Lesion Index-Guided Ablation Facilitates Continuous, Transmural, and Durable Lesions in a Porcine Recovery Model. Circ Arrhythm Electrophysiol. 2018;11:e005892.
doi: 10.1161/CIRCEP.117.005892
Mattia L, Crosato M, Indiani S, Causin E, Licciardello C, Maria Squasi PA, et al. Prospective Evaluation of Lesion Index-Guided Pulmonary Vein Isolation Technique in Patients with Paroxysmal Atrial Fibrillation: 1-year Follow-Up. J Atr Fibrillation. 2018;10:1858.
doi: 10.4022/jafib.1858
Lin C-Y, Te ALD, Lin Y-J, et al. High-resolution mapping of pulmonary vein potentials improved the successful pulmonary vein isolation using small electrodes and inter-electrode spacing catheter. Int J Cardiol. 2018;272:90–6.
doi: 10.1016/j.ijcard.2018.06.062
Anter E, Tschabrunn CM, Josephson ME. High-Resolution Mapping of Scar-Related Atrial Arrhythmias Using Smaller Electrodes With Closer Interelectrode Spacing. Circ Arrhythm Electrophysiol. 2015;8:537–45.
doi: 10.1161/CIRCEP.114.002737
Masuda M, Fujita M, Iida O, Okamoto S, Ishihara T, Nanto K, et al. The identification of conduction gaps after pulmonary vein isolation using a new electroanatomic mapping system. Heart Rhythm. 2017;14:1606–14.
doi: 10.1016/j.hrthm.2017.08.016
Tedrow UB, Stevenson WG. Recording and interpreting unipolar electrograms to guide catheter ablation. Heart Rhythm. 2011;8:791–6.
doi: 10.1016/j.hrthm.2010.12.038
Iso K, Watanabe I, Kogawa R, Okumura Y, Nagashima K, Takahashi K, et al. Wavefront direction and cycle length affect left atrial electrogram amplitude. J Arrhythm. 2017;33:269–74.
doi: 10.1016/j.joa.2017.01.001
Garcia-Bolao I, Ballesteros G, Ramos B, et al. Identification of pulmonary vein reconnection gaps with high-density mapping in redo atrial fibrillation procedures. Europace. 2018;20:f351–8.
doi: 10.1093/europace/eux184
McGarry TJ, Narayan SM. The Anatomical Basis of Pulmonary Vein Reconnection After Ablation for Atrial Fibrillation: Wounds That Never Felt a Scar? J Am Coll Cardiol. 2012;59:939–41.
doi: 10.1016/j.jacc.2011.11.032
Kowalski M, Grimes MM, Perez FJ, Kenigsberg DN, Koneru J, Kasirajan V, et al. Histopathologic Characterization of Chronic Radiofrequency Ablation Lesions for Pulmonary Vein Isolation. J Am Coll Cardiol. 2012;59:930–8.
doi: 10.1016/j.jacc.2011.09.076