Clinical impact of high-density mapping on the acute and long term outcome of atypical atrial flutter ablations

Cori, Andrea Di; Mazzocchetti, L; Parollo, M; Giannotti, M; Canu, A; Barletta, Valentina; Volpe, Salvatore; Lucia, R De; Viani, Stefano; Segreti, Luca; Soldati, Ezio; Zucchelli, Giulio; Bongiorni, Maria Grazia

doi:10.1007/s10840-022-01121-3

Cited by 6 publications

(11 citation statements)

References 21 publications

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“…Previous cohort studies that evaluated HD Mapping for the ablation of AAFls have found acute procedural outcomes that are similar to this study (Table 5 2,3,5,7–10 ). However, the 1‐year atrial flutter recurrence rate of this cohort was relatively high compared to other studies.…”

Section: Discussionsupporting

confidence: 81%

“…However, the 1‐year atrial flutter recurrence rate of this cohort was relatively high compared to other studies. Three cohort studies also reported results of regression analyses, 2,3,5 but none of the predictors that were specified in these studies were found to be associated with atrial flutter recurrence in this cohort. Presence of flutters with a non‐identified circuit and absence of critical isthmus ablation were not evaluated in the other cohort studies.…”

Section: Discussionmentioning

confidence: 86%

“…This was recently reported in observational studies that found that HD mapping-guided catheter ablation of AAFl resulted in higher rates of procedural success than procedures guided by conventional mapping systems. 2,5 These improved outcomes have been attributed to the enhanced signal acquisition and processing capabilities of HD mapping systems that may Ineffective ablation entails the presence of an ablation lesion that does not block the flutter circuit, resulting in recurrence of the same atrial flutter. Although the introduction of irrigated-tip and contact-force sensing ablation catheters have improved ablation lesion formation, 12,13 the presence of epicardial structures (e.g., Vein of Marshall, 14 septopulmonary bundle 15 ) or the necessity for long ablation lesions can yield the creation of durable block challenging.…”

Section: Benefits Of Hd Mappingmentioning

confidence: 99%

“…2,3,5,[7][8][9][10] The studies of Di Cori, Balt, and Maury included multiple mapping techniques, only the results of HD mapping techniques were included in this table.…”

mentioning

confidence: 99%

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High‐density mapping for ablation of atypical atrial flutters – procedural characteristics related to outcome

Abeln,

Balt,

Klaver

et al. 2023

Pacing Clinical Electrophis

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BackgroundHigh‐density (HD) mapping is increasingly used to characterize arrhythmic substrate for ablation of atypical atrial flutters (AAFl). However, results on clinical outcomes and factors that are associated with arrhythmia recurrence are scarce.MethodsSingle‐center, prospective, observational cohort study that enrolled patients with catheter ablation for AAFl using a HD mapping system and a grid‐shaped mapping catheter. Procedural characteristics, rates of atrial flutter recurrence, and factors that were associated with atrial flutter recurrence were evaluated.ResultsSixty‐one patients with a total of 94 AAFl were included in the cohort. HD mapping was used to successfully identify the flutter circuit of 80/94 AAFl. The circuit was not identified for 14/94 AAFl in 11 patients. Critical isthmuses were identified and ablated in 29 patients (48%). Acute procedural success was achieved in 52 patients (85%), and 37 patients (61%) remained free from atrial flutter recurrence during a follow up of 1.3 [1.0–2.1] years. Atrial flutter recurrence was univariably associated with presence of a non‐identified flutter circuit (HR:2.6 95% CI [1.1–6.3], p = .04) and critical isthmus‐targeted ablation (HR:0.4 [0.15–0.90], p = .03). In multivariable regression analyses, critical isthmus ablation remained significant (HR:0.4 [0.16–0.97], p = .04), whereas presence of a non‐identified flutter did not (HR:2.4 [0.96–5.8], p = .06).ConclusionHD mapping was successfully used to identify the majority of AAFl circuits. Ablation resulted in freedom from atrial flutter recurrence in 61% of the cohort. Successful identification of all flutter circuits and critical isthmuses appears to be beneficial for long‐term outcomes.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 86%

Section: Benefits Of Hd Mappingmentioning

confidence: 99%

“…2,3,5,[7][8][9][10] The studies of Di Cori, Balt, and Maury included multiple mapping techniques, only the results of HD mapping techniques were included in this table.…”

mentioning

confidence: 99%

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High‐density mapping for ablation of atypical atrial flutters – procedural characteristics related to outcome

Abeln,

Balt,

Klaver

et al. 2023

Pacing Clinical Electrophis

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“…Although the safety, efficacy, and effectiveness of AF ablation are consistently improved in the last decade, [ 13 , 14 ] procedural management may be complex, and life-threatening complications continue to be observed [ 15 ]. Nevertheless, indications are expanding to ever sicker patients, such as those with advanced age, obesity, and cardiomyopathy [ 16 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Accuracy of Noninvasive Continuous Arterial Pressure Monitoring during Transcatheter Atrial Fibrillation Ablation

Cori

Parollo

Fiorentini

et al. 2023

JCM

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Introduction: Transcatheter atrial fibrillation (AF) ablation is still carried out with continuous invasive radial arterial blood pressure (IBP) monitoring in many centers. Continuous noninvasive blood pressure (CNBP) measurement using the volume-clamp method is a noninvasive alternative method used in ICU. No data on CNBP reliability are available in the electrophysiology lab during AF ablation, where rhythm variations are common. Background: The objective of the present study was to compare continuous noninvasive arterial pressure measured with the ClearSight device (Edwards Lifesciences, Irvine, CA, USA) with invasive radial artery pressure used as the reference method during AF ablation. Methods: We prospectively enrolled 55 consecutive patients (age 62 ± 11 years, 80% male) undergoing transcatheter AF ablation (62% paroxysmal, 38% persistent) at our center. Standard of care IBP monitoring via a radial cannula and a contralateral noninvasive finger volume-clamp CNBP measurement device were positioned simultaneously in all patients for the entire procedure. Bland-Altman analysis was used to analyze the agreement between the two techniques. Results: A total of 1219 paired measurements for systolic, diastolic, and mean arterial pressure were obtained in 55 subjects, with a mean (SD) of 22 (9) measurements per patient. The mean bias (SD) was −12.97 (13.89) mmHg for systolic pressure (level of agreement −14.24–40.20; correlation coefficient 0.84), −1.85 (8.52) mmHg for diastolic pressure (level of agreement −18.54–14.84; correlation coefficient 0.77) and 2.31 (8.75) mmHg for mean pressure (level of agreement −14.84–19.46; correlation coefficient 0.85). Conclusion: In patients undergoing AF ablation, CNBP monitoring with the ClearSight device showed acceptable agreement with IBP monitoring. Larger studies are needed to confirm the potential clinical implications of continuous noninvasive BP monitoring during AF ablation.

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Automated prediction of isthmus areas in scar‐related atrial tachycardias using artificial intelligence

Saluja,

Huang,

Majumder

et al. 2024

Cardiovasc electrophysiol

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IntroductionAblation of scar‐related reentrant atrial tachycardia (SRRAT) involves identification and ablation of a critical isthmus. A graph convolutional network (GCN) is a machine learning structure that is well‐suited to analyze the irregularly‐structured data obtained in mapping procedures and may be used to identify potential isthmuses.MethodsElectroanatomic maps from 29 SRRATs were collected, and custom electrogram features assessing key tissue and wavefront properties were calculated for each point. Isthmuses were labeled off‐line. Training data was used to determine the optimal GCN parameters and train the final model. Putative isthmus points were predicted in the training and test populations and grouped into proposed isthmus areas based on density and distance thresholds. The primary outcome was the distance between the centroids of the true and closest proposed isthmus areas.ResultsA total of 193 821 points were collected. Thirty isthmuses were detected in 29 tachycardias among 25 patients (median age 65.0, 5 women). The median (IQR) distance between true and the closest proposed isthmus area centroids was 8.2 (3.5, 14.4) mm in the training and 7.3 (2.8, 16.1) mm in the test group. The mean overlap in areas, measured by the Dice coefficient, was 11.5 ± 3.2% in the training group and 13.9 ± 4.6% in the test group.ConclusionA GCN can be trained to identify isthmus areas in SRRATs and may help identify critical ablation targets.

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Clinical impact of high-density mapping on the acute and long term outcome of atypical atrial flutter ablations

Cited by 6 publications

References 21 publications

High‐density mapping for ablation of atypical atrial flutters – procedural characteristics related to outcome

High‐density mapping for ablation of atypical atrial flutters – procedural characteristics related to outcome

Feasibility and Accuracy of Noninvasive Continuous Arterial Pressure Monitoring during Transcatheter Atrial Fibrillation Ablation

Automated prediction of isthmus areas in scar‐related atrial tachycardias using artificial intelligence

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