Comparison of ablation outcomes of the second ablation procedure for recurrent atrial fibrillation using an ultra‐high‐resolution mapping system and conventional mappings system

Abstract

Background The utility of an ultra‐high‐resolution electroanatomical mapping system (UHR‐EAM, Rhythmia) for repeat atrial fibrillation (AF) ablation has not been evaluated. Hypothesis A second AF ablation procedure performed using UHR‐EAM may demonstrate different outcomes compared with that using a conventional electroanatomical mapping system (C‐EAM, CARTO3). Method This observational study enrolled consecutive patients who underwent a second AF ablation procedure using UHR‐EAM (n = 103) and C‐EAM (n = 153). The second ablation procedure included re‐isolation of reconnected pulmonary veins (PVs) and elimination of clinical or induced non‐PV AF triggers and atrial tachycardia (AT). Other empirical ablations were additionally conducted at the discretion of the operators. Results Re‐isolation of PVs was achieved in 196 patients who had ≥1 left atrial‐PV reconnection. The elimination rate of AT was higher in the UHR‐EAM group than the C‐EAM group (87% vs 65%, P = .040), while that of non‐PV AF triggers was similar (63% vs 63%, P = 1.00). The UHR‐EAM demonstrated shorter radiofrequency application time (21.8 ± 16.8 vs 28.0 ± 21.3 minutes, P = .017), but longer fluoroscopic time (26.2 ± 12.6 vs 21.4 ± 9.3 minutes, P = .0001). No severe complication developed. The total 1‐year AF/AT‐free survival rates were similar between the two groups (off AADs, 59.2% vs 56.2%, P = .62; on AADs, 65.0% vs 69.3%, P = .49). Conclusion The efficacy and safety outcomes of repeat AF ablation using UHR‐EAM was comparable to those using C‐EAM.

Single‐center experience of ultra‐high‐density mapping guided catheter ablation of focal atrial tachycardia

“…After initial experiences with UHDM in animal models, several studies have reported feasibility, safety and also beneficial effects on a variety of radiofrequency ablation procedures for a variety of rhythm disorders. 10 , 11 , 12 , 13 , 15 , 19 , 20 Comparison of UHDM and CEAM for first Do PVI procedures could demonstrate a more than fivefold increased EGM density in operators familiar with UHDM. 10 Map creation with UHDM mapping was significantly faster compared to the CEAM group in our study.…”

“…The innovative shape and construction of the mini‐basket mapping catheter with 64 closely arranged microelectrodes enables high resolution with superior density of electrograms and allows both, acquisition of activation timing and voltage data in a short time. After initial experiences with UHDM in animal models, several studies have reported feasibility, safety and also beneficial effects on a variety of radiofrequency ablation procedures for a variety of rhythm disorders 10–13,15,19,20 . Comparison of UHDM and CEAM for first Do PVI procedures could demonstrate a more than fivefold increased EGM density in operators familiar with UHDM 10 .…”

A U.K. Multicenter Retrospective Study of the Learning Curve and Relative Impact on Success Rates and Procedural Metrics of the RHYTHMIA HDx™ Mapping System

“… 4 There were no significant differences in procedure times, but 2 studies noted a reduction in ablation time, similar to our findings. 14 , 15 There were contrasting results for fluoroscopy, with 1 study finding a reduction with RHYTHMIA HDx™, 16 1 finding a reduction with CARTO ® 3, 13 and 1 reporting no significant difference. 15 Acute procedural success was 100% in almost all studies.…”

“… 14 , 15 There were contrasting results for fluoroscopy, with 1 study finding a reduction with RHYTHMIA HDx™, 16 1 finding a reduction with CARTO ® 3, 13 and 1 reporting no significant difference. 15 Acute procedural success was 100% in almost all studies. Pooled 6- and 12-month clinical outcomes were not significantly different between RHYTHMIA HDx™ and CARTO ® 3 procedures (80.3%/71.6% vs. 73.8%/65.7%).…”