PVI isolation could be performed with the new multielectrode array Globe in all 12 PVs offering the option for easy handling and fast "single-shot" PVI. Several continuously updated mapping types from 122 electrodes even in real time during ablation demonstrate the capability to go beyond PVI for voltage mapping plus substrate modification, and for rotor mapping plus rotor ablation.
Targeted and focal ablation in the region of Bachmann's bundle is a novel and feasible technique to achieve complete isolation of the left atrial anteroseptal fibrotic area.
On the cover: The cover image, by Hans Kottkamp MD et al., is based on the Original Article Global multielectrode contact mapping plus ablation with a single catheter: Preclinical and preliminary experience in humans with atrial fibrillation, DOI: https://doi.org/10.1111/jce.13310.
Introduction
The critical question for technological advancement of catheter ablation of atrial fibrillation (AF) is whether a creative new concept can combine and even improve the options of single‐tip catheters with the simplicity of the use of balloon catheters. Herein are described the results from the first clinical study of a new multielectrode contact‐mapping plus ablation array (Globe) offering such a complete solution.
Methods and Results
The multielectrode Globe array consists of 16 flat ribs with 122 gold‐plated electrodes. Each electrode can record electrograms, ablate, pace, and can measure tissue contact and temperature. Single‐shot pulmonary vein isolation (PVI) is possible with temperature‐guided ablation of up to 24 electrodes simultaneously with automatic, individual power control of every electrode. Sixty patients with symptomatic AF underwent PVI using the Globe. In all sixty patients, acute PVI was achieved in 232 of 234 attempted PVs (99.1%). In 34 patients treated with “single‐hot‐shot” ablation, PVI was achieved in 136 of 136 PVs (100%). Single‐procedure 12‐month freedom from AF off antiarrhythmic drugs in the “single‐hot‐shot” group was 75.5% and freedom from AF/atrial tachycardia 72.3%. In two patients, pericardial tamponade was observed, one after a transseptal puncture, and one during array insertion with an over‐advanced sheath. There were no other device‐related serious adverse events, including stroke, PV stenosis, esophageal perforation, or phrenic nerve palsy.
Conclusions
In this first clinical series, the Globe catheter was found to be an easy‐to‐use system for single‐shot PVI. The continuously updated multielectrode voltage and activation mapping data indicate future options for mapping and ablation beyond PVI.
In the last years, atrial fibrosis was shown to be an independent predictor of procedural failure in patients with paroxysmal and persistent atrial fibrillation. Ablation strategies have been developed to improve the outcome of catheter ablation by targeting detected areas of fibrosis, based either on endocardial voltage mapping or cardiac magnetic resonance. Box isolation of fibrotic areas (BIFA) is a new and promising patient-tailored ablation strategy for atrial fibrillation patients targeting substantial fibrotic areas by circumferential isolation of left atrial fibrosis.
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