Ablation in Persistent Atrial Fibrillation Using Stochastic Trajectory Analysis of Ranked Signals (STAR) Mapping Method

Honarbakhsh, Shohreh; Hunter, Ross J.; Ullah, Waqas; Keating, Emily; Finlay, Malcolm; Schilling, Richard J.

doi:10.1016/j.jacep.2019.04.007

Cited by 42 publications

(98 citation statements)

References 24 publications

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“…Fifty patients were included. The outcome of STAR mapping through panoramic recordings with basket catheters has been reported previously for the 15 patients undergoing mapping of AT, and for the 35 patients undergoing mapping of AF (Figure ). Baseline characteristics are demonstrated in Table .…”

Section: Resultsmentioning

confidence: 67%

“…During an average follow‐up of 19.4 ± 3.7 months (all patients reached ≥12 months follow‐up), 28 patients (80%) were free from AF/AT, off antiarrhythmic drugs. Of the seven patients that had recurrent AF/AT during follow‐up, six had documented AT of which all underwent successful AT ablation …”

Section: Resultsmentioning

confidence: 99%

“…Global and sequential STAR maps were created using basket (Constellation; Boston Scientific, Natick, MA or FIRMap Abbott, CA) and PentaRay catheter unipolar recordings respectively. In this setting, the activation times are compared between electrode pairs that are within a predefined geodesic distance ensuring that the electrodes are mapping the same anatomical surface and avoids ascribing a relationship between two regions that are separated by a distance and activated by unrelated wavefronts. For both AT and AF cases, the basket catheter was then removed and conventional multipolar catheters were used to create sequential STAR maps.…”

Section: Methodsmentioning

confidence: 99%

“…A minimum of two 5‐minute basket catheter recordings were acquired to create global STAR maps (Supporting Information Method) pre‐ and post‐pulmonary vein isolation (PVI) as described for this cohort previously . A minimum of 10 recordings each of 30 seconds was acquired with the PentaRay catheter to achieve adequate LA coverage.…”

Section: Methodsmentioning

confidence: 99%

“…The STAR mapping method has been validated in vivo and in human studies mapping atrial tachycardias (ATs) . It has also been used to guide ablation in persistent AF using global mapping with basket catheters, which has resulted in a significant response to ablation with targeting of ESA and high freedom from AF/AT during follow‐up …”

Section: Introductionmentioning

confidence: 99%

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STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping

Honarbakhsh

Schilling

Finlay

et al. 2019

Cardiovasc electrophysiol

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Introduction The optimal way to map localized drivers in persistent atrial fibrillation (AF) remains unclear. The objective of the study was to apply a novel vector mapping approach called Stochastic Trajectory Analysis of Ranked signals (STAR) in AF. Methods and Results Patients having persistent AF ablation were included. Early sites of activation (ESA) identified on global STAR maps created with basket catheters were used to guide AF ablation post‐pulmonary vein isolation (PVI). All patients also had sequential STAR maps created with ≥10 PentaRay recordings of 30 seconds. These were validated offline in their ability to identify the ESA targeted with a study‐defined ablation response (AF termination or cycle length [CL] slowing of ≥30 ms). Thirty‐two patients were included in whom 92 ESA were identified on the global STAR maps, with 73 of 83 targeted sites demonstrating an ablation response (24 AF termination and 49 CL slowing). Sixty‐one out of 73 (83.6%) ESA were also identified on the sequential STAR maps. These showed greater consistency (P < .001), were seen pre‐ and post‐PVI (P < .001) and were more likely to be associated with AF termination on ablation (P = .007). The sensitivity and specificity of sequential mapping for the detection of ESA with an ablation response was 84.9% (95% confidence interval [CI] = 74.6‐92.2) and 90.0% (95% CI = 55.5‐99.8), respectively. During a follow‐up of 19.4 ± 3.7 months, 28 (80%) patients were free from AF/atrial tachycardia. Conclusions STAR mapping consistently identified ESA in all patients and the ablation response was compatible with ESA being driver sites. Mechanistically important ESA were successfully identified using sequential recordings.

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Section: Resultsmentioning

confidence: 67%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping

Honarbakhsh

Schilling

Finlay

et al. 2019

Cardiovasc electrophysiol

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Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation

Lin,

Higa

et al. 2023

JAMA Netw Open

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ImportanceCatheter ablation for persistent atrial fibrillation (AF) has shown limited success.ObjectiveTo determine whether AF drivers could be accurately identified by periodicity and similarity (PRISM) mapping ablation results for persistent AF when added to pulmonary vein isolation (PVI).Design, Setting, and ParticipantsThis prospective randomized clinical trial was performed between June 1, 2019, and December 31, 2020, and included patients with persistent AF enrolled in 3 centers across Asia. Data were analyzed on October 1, 2022.InterventionPatients were assigned to the PRISM-guided approach (group 1) or the conventional approach (group 2) at a 1:1 ratio.Main Outcomes and MeasuresThe primary outcome was freedom from AF or other atrial arrhythmia for longer than 30 seconds at 6 and 12 months.ResultsA total of 170 patients (mean [SD] age, 62.0 [12.3] years; 136 men [80.0%]) were enrolled (85 patients in group 1 and 85 patients in group 2). More group 1 patients achieved freedom from AF at 12 months compared with group 2 patients (60 [70.6%] vs 40 [47.1%]). Multivariate analysis indicated that the PRISM-guided approach was associated with freedom from the recurrence of atrial arrhythmia (hazard ratio, 0.53 [95% CI, 0.33-0.85]).Conclusions and RelevanceThe waveform similarity and recurrence pattern derived from high-density mapping might provide an improved guiding approach for ablation of persistent AF. Compared with the conventional procedure, this novel specific substrate ablation strategy reduced the frequency of recurrent AF and increased the likelihood of maintenance of sinus rhythm.Trial RegistrationClinicalTrials.gov Identifier: NCT05333952

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Mapping atrial fibrillation

Kowalewski

2021

Herz

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Ablation in Persistent Atrial Fibrillation Using Stochastic Trajectory Analysis of Ranked Signals (STAR) Mapping Method

Cited by 42 publications

References 24 publications

STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping

STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping

Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation

Mapping atrial fibrillation

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