Find Me If You Can: First Clinical Experience Using the Novel CARTOFINDER Algorithm in a Routine Workflow for Atrial Fibrillation Ablation

Abstract

Aims: The CARTOFINDER module allows for simultaneous and automated detection of repetitive focal and rotational activations in patients with atrial arrhythmias. This study aimed to validate the CARTOFINDER algorithm for the detection of potential drivers for atrial fibrillation (AF) and to access their potential impact on individual arrhythmia substrates. Methods: Fifty consecutive patients underwent AF ablation for persistent AF (PERS), using a 3D-mapping system with the integrated CARTOFINDER module. Regions of interest (ROIs) were identified before and after ablation, and their spatial and temporal relationship was correlated with areas of fibrosis. Results: Procedural success was achieved in all patients and 42% received ablation beyond pulmonary vein isolation (PVI). AF termination was observed in 6 patients (12%). The mean procedure duration was 134 ± 29 min. ROIs were revealed in all patients (mean n = 77 ± 52) and there was no statistical evidence for a predilection site. There was no significant anatomical correlation between ROIs and bipolar low voltage. Remapping confirmed the elimination of ROIs in relation to the individual ablation site, a limited reproducibility of rotational ROIs and persistent focal activity over time in some anatomical segments. ROIs were not a predictor for AF recurrence during following ablation. Conclusions: CARTOFINDER mapping can be integrated into a routine workflow for AF ablation. ROIs could be discriminated in all patients and an ablation effect was observed in some patients, whereas persistent activity was found in certain anatomical segments, even after ablation. ROIs might be an additional ablation target when we are able to understand the individual substrate.

Long-term outcome of patients with long-standing persistent atrial fibrillation undergoing ablation guided by a novel high-density panoramic mapping system: A propensity score matching study

“…If >2 early QS wave patterns are detected within a 2-second window, a focal source is considered to exist ( Figure 2 A). 18

Figure 2 Examples of CARTOFINDER-identified activities. A: Focal activity near the posterior antrum of the left superior pulmonary vein.

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“…Two or more such pansystolic activations for which at least 80% of the electrodes follow the same propagation pattern are defined as rotational activity ( Figure 2 B). 18 …”

News from the Cold Chamber: Clinical Experiences of POLARx versus Arctic Front Advance for Single-Shot Pulmonary Vein Isolation

“…Complete pulmonary vein isolation (PVI) represents the cornerstone of this procedure [1]. As CB-guided single-shot PVI is associated with shorter procedure times, an improved learning curve and a higher degree of lesion reproducibility it provides a valid alternative to radiofrequency (RF)-guided catheter ablation [1, [4][5][6][7]. Over the past 15 years, much experience has been gained with the established AFA-CB (Arctic Front Advance (Pro), AFA, Medtronic) [1, 5,[8][9][10][11][12][13].…”

Future Directions for Mapping Atrial Fibrillation

“…Mapping using CARTOFINDER can be integrated into routine clinical workflows, as it requires no additional equipment if one is already using CARTO for AF ablation if the software module is present. [ 41 ] Mapping shows focal and rotational activation patterns as regions of interest (ROI).…”

“…In recent series, there does not appear to be a relationship between these sites and low bipolar voltage as measured by the PENTARAY, in contrast to earlier work using basket catheters. [ 41 , 42 ] Given the large number of institutions that use CARTO mapping as part of an AF ablation, more systematically collected data are emerging to guide mechanistic insight and tailored therapy approaches using this method.…”