Efficacy and safety of driver‐guided catheter ablation for atrial fibrillation: A systematic review and meta‐analysis

Abstract

Pooled data on the efficacy of AF driver-guided catheter ablation suggest increased freedom from AF/AT relative to conventional strategies. However, most studies are nonrandomized and of moderate quality. Though promising data exist, there remains no conclusive evidence for the efficacy of AF driver ablation. Robust data from randomized trials are needed.

2019 APHRS expert consensus statement on three‐dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS

“…Lin et al, Haissaguerre et al, and Narayan et al used phase mapping‐based strategy to identify rotors during procedures, while Atienza et al, Jadidi et al, and Seitz et al used activation‐based strategy to identify rotors (Table 7‐2). Pooled data on the efficacy of rotor‐guided AF ablation suggest increased freedom from AF/AT relative to conventional strategies . Rotor‐guided ablation has emerged as a potential therapeutic target for persistent AF ablation.…”

“…[168][169][170] Pooled data on the efficacy of rotor-guided AF ablation suggest increased freedom from AF/AT relative to conventional strategies. 171 Rotor-guided ablation has emerged as a potential therapeutic target for persistent AF ablation. Robust data from randomized trials with a standardized rotor-mapping protocol are still needed.…”

Comparison of phase mapping and electrogram‐based driver mapping for catheter ablation in atrial fibrillation

“…Previous meta-analyses of trials comparing additional driver-guided ablation with the traditional approach have supported the possible benefit of a combined approach of driver-guided ablation, which includes the phase mapping and electrogram-based technique, and PVI in improving single-procedure freedom from all arrhythmias in the population with mixed AF type. 25,26 Another meta-analysis focused on studies using FIRM mapping (phase mapping based, RhythmView, Abbott Medical) to identify rotors in the mixed AF type. 27 Although the pooled dataset favor the rotor ablation by using FIRM mapping, there was a marked heterogeneity between studies and wide variability in success rates between different centers performing rotor ablations.…”

Source Determination in Atrial Fibrillation

“…One recent study looked at a much simpler electrogram activation map-guided approach. 30 In this study, a 20-pole high-density mapping catheter was used to visually identify sites of centrifugal activity presumed to be AF sources. These sites were ablated along with sites where there was defragmentation.…”