Individualized ablation strategy to treat persistent atrial fibrillation: Core-to-boundary approach guided by charge-density mapping

Shi, Rui; Chen, Zhong; Pope, Michael; Zaman, Junaid A.B.; Debney, Mike; Marinelli, Alessio; Boyalla, Vennela; Sathishkumar, Anitha; Karim, N; Cantor, E; Valli, Haseeb; Haldar, Shouvik; Jones, David G.; Hussain, Wajid; Markides, Vias; Betts, Timothy R.; Wong, Tom

doi:10.1016/j.hrthm.2021.02.014

Cited by 20 publications

(25 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Acute AF termination during ablation was a relatively infrequent occurrence in this study, but freedom from AF observed after ablation in this and other studies using this mapping system suggests that areas of CDA identified for ablation were involved in maintenance of AF 18,35 …”

Section: Discussionmentioning

confidence: 48%

Characterization of persistent atrial fibrillation with non‐contact charge density mapping and relationship to voltage

Lee

Nelson

Clayton

et al. 2021

Journal of Arrhythmia

View full text Add to dashboard Cite

Background Despite studies using localized high density contact mapping and lower resolution panoramic approaches, the mechanisms that sustain human persistent atrial fibrillation (AF) remain unresolved. Voltage mapping is commonly employed as a surrogate of atrial substrate to guide ablation procedures. Objective To study the distribution and temporal stability of activation during persistent AF using a global non‐contact charge density approach and compare the findings with bipolar contact mapping. Methods Patients undergoing either redo or de novo ablation for persistent AF underwent charge density and voltage mapping to guide the ablation procedure. Offline analysis was performed to measure the temporal stability of three specific charge density activation (CDA) patterns, and the degree of spatial overlap between CDA patterns and low voltage regions. Results CDA was observed in patient‐specific locations that partially overlapped, comprising local rotational activity (18% of LA), local irregular activity (41% of LA), and focal activity (39% of LA). Local irregular activity had the highest temporal stability. LA voltage was similar in regions with and without CDA. Conclusion In persistent AF, CDA patterns appear unrelated to low voltage areas but occur in varying locations with high temporal stability.

show abstract

Section: Discussionmentioning

confidence: 48%

Characterization of persistent atrial fibrillation with non‐contact charge density mapping and relationship to voltage

Lee

Nelson

Clayton

et al. 2021

Journal of Arrhythmia

View full text Add to dashboard Cite

show abstract

“…To date, most studies have suggested that the effect of additional ablation is negative, thus, in the current clinical practice, an individualized ablation strategy is often adopted for patients with PeAF. [ 33 ]. An individualized CA strategy for PeAF may be more crucial in the context of HF.…”

Section: Discussionmentioning

confidence: 99%

Optimal Catheter Ablation Strategy for Patients with Persistent Atrial Fibrillation and Heart Failure: A Retrospective Study

He²,

et al. 2022

Cardiology Research and Practice

View full text Add to dashboard Cite

The optimal catheter ablation (CA) strategy for patients with persistent atrial fibrillation (PeAF) and heart failure (HF) remains uncertain. Between 2016 and 2020, 118 consecutive patients with PeAF and HF who underwent the CA procedure in two centers were retrospectively evaluated and divided into the pulmonary vein isolation (PVI)-only and PVI + additional ablation groups. Transthoracic echocardiography (TTE) was performed at baseline, one month, and 12 months after the CA procedure. The HF symptoms and left ventricular ejection fraction (LVEF) improvements were analyzed. Fifty-six patients underwent PVI only, and 62 patients received PVI with additional ablation. Compared with the baseline, a significant improvement in the LVEF and left atrial diameter postablation was observed in all patients. No significant HF improvement was detected in the PVI + additional ablation group than in the PVI-only group (74.2% vs. 71.4%, P = 0.736 ), but the procedure and ablation time were significantly longer (137.4 ± 7.5 vs. 123.1 ± 11.5 min, P = 0.001 ). There was no significant difference in the change in TTE parameters and the number of rehospitalizations. For patients with PeAF and HF, CA appears to improve left ventricular function. Additional ablation does not improve outcomes and has a significantly longer procedure time. Trial registration number is as follows: ChiCTR2100053745 (Chinese Clinical Trial Registry; https://www.chictr.org.cn/index.aspx).

show abstract

“…We have described a 'core-to-boundary' approach that aims to deliver focused ablation to the core of sites of preferential conduction patterns while anchoring these regions to non-conducting boundaries to reduce the risk of generating substrate for organised macro-re-entrant atrial tachycardias (AT). 54 This strategy compliments an approach of 'map, ablate, re-map' that takes advantage of the speed of map recording and generation to allow repeated evaluation of the impact of ablation delivered, alterations to the dynamic patterns of AF activation and identification of stable or emerging areas of interest.…”

Section: Ablation Strategymentioning

confidence: 99%

“…The number of conduction pattern sites appears related to the individual AF phenotype and is greater in patients in AF at the start of the procedure, compared to patients in whom AF is induced, and is proportional to the duration of persistent AF. 54,55 Although definitive evidence of the optimal endpoint for ablation is lacking, we propose a strategy focused on sequential ablation of sites of preferential conduction patterns across both chambers until either all sites are eliminated or AF terminates to either AT or sinus rhythm. This supports a low threshold for mapping and ablation of RA mechanisms following ablation in the LA but without incremental addition of empirical ablation with the aim of achieving sinus rhythm in all patients.…”

Section: Ablation Strategymentioning

confidence: 99%

Global Substrate Mapping and Targeted Ablation with Novel Gold-tip Catheter in De Novo Persistent AF

Pope

Betts

2022

Arrhythm Electrophysiol Rev

View full text Add to dashboard Cite

Results from catheter ablation for persistent AF are suboptimal, with no strategy other than pulmonary vein isolation showing clear benefit. Recently employed empirical strategies beyond pulmonary vein isolation involve widespread atrial ablation in all patients and do not take into account patient-specific differences in AF mechanisms or phenotype. Charge density mapping using the non-contact AcQMap system (Acutus Medical) allows visualisation of whole-chamber activation during AF and reveals localised patterns of complex activation thought to represent important mechanisms for AF maintenance that can be targeted with focal ablation. In this review, the authors outline the fundamentals of this technology, the initial data exploring the mechanistic role of activation patterns seen and the application to ablation of persistent AF.

show abstract

Individualized ablation strategy to treat persistent atrial fibrillation: Core-to-boundary approach guided by charge-density mapping

Cited by 20 publications

References 22 publications

Characterization of persistent atrial fibrillation with non‐contact charge density mapping and relationship to voltage

Characterization of persistent atrial fibrillation with non‐contact charge density mapping and relationship to voltage

Optimal Catheter Ablation Strategy for Patients with Persistent Atrial Fibrillation and Heart Failure: A Retrospective Study

Global Substrate Mapping and Targeted Ablation with Novel Gold-tip Catheter in De Novo Persistent AF

Contact Info

Product

Resources

About