Safety and efficacy of catheter ablation on patients with persistent atrial fibrillation by targeting repetitive activation patterns and focal impulses

Abstract

Background The study is intended to evaluate the acute and long‐term effectiveness and peri‐procedural safety in ablation of persistent atrial fibrillation (PsAF) using the CartoFinder algorithm guided ablation (CFGA) targeting on repetitive activation patterns (RAPs) and focal impulses (FIs) identified in dynamic maps. Methods This is a prospective, single‐arm, multicenter study. A 64‐pole multielectrode basket catheter was used for intracardiac global electrogram (EGM) mapping. The RAPs or FIs were repeatedly mapped and ablated for up to five iterations by the CartoFinder algorithm to achieve sinus rhythm (SR) or organized atrial tachycardia (AT), which were followed by PVI. All patients were followed up for 12 months after procedure. Results Sixty‐four PsAF patients (age, 60.7 ± 9.1 years; male, 76.6%; median PsAF duration, 6.0 months) underwent CFGA on RAPs/FIs. Six patients (9.4%) reported primary adverse event (PAE) including groin hematoma (2), complete heart block (1), tamponade (1), pericarditis (1), and pseudoaneurysm (1). Repeated mapping and ablation on RAPs/FIs resulted in the cycle length (CL) increase from 191.0 ± 167.6 ms at baseline to 365.7 ± 296.7 ms in the LA and from 167.8 ± 41.6 ms to 379.4 ± 293.5 ms in the RA and 30.2% (19/63) AF termination to SR or organized AT. The 12‐month arrhythmia‐free and symptomatic AF‐free rates were 60.9% and 75.0%, respectively. Patients with acute AF termination showed a higher 12‐month arrhythmia‐free rate (76.9%) than those without (50.0%, p = .04). Conclusions The study demonstrated that the CartoFinder algorithm can be used for global activation mapping during PsAF ablation. Patients with acute AF termination had a lower 12‐month AF recurrence rate compared to patients without.