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Initial experience of the High-Density Grid catheter in patients undergoing catheter ablation for atrial fibrillation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

A significant proportion of patients undergoing catheter ablation for atrial fibrillation (AF) experience arrhythmia recurrence. This is mostly due to pulmonary vein reconnection (PVR). Whether mapping using High-Density Wave (HDW) technology is superior to standard bipolar (SB) configuration at detecting PVR is unknown. We aimed to evaluate the efficacy of HDW technology compared to SB mapping in identifying PVR.

Methods

High-Density (HD) multipolar Grid catheters were used to create left atrial geometries and voltage maps in 36 patients undergoing catheter ablation for AF (either due to recurrence of an atrial arrhythmia from previous AF ablation or de novo AF ablation). Nineteen SB maps were also created and compared. Ablation was performed until pulmonary vein isolation was achieved.

Results

Median time of mapping with HDW was 22.3 [IQR: 8.2] min. The number of points collected with HDW (13299.6±1362.8 vs 6952.8±841.9, p<0.001) and used (2337.3±158.0 vs 1727.5±163.8, p<0.001) was significantly higher compared to SB. Moreover, HDW was able to identify more sleeves (16 for right and 8 for left veins), where these were confirmed electrically silent by SB, with significantly increased PVR sleeve size as identified by HDW (p<0.001 for both right and left veins). Importantly, with the use of HDW, the ablation strategy changed in 23 patients (64% of targeted veins) with a significantly increased number of lesions required as compared to SB for right (p=0.005) and left veins (p=0.003).

Conclusion

HDW technology is superior to SB in detecting pulmonary vein reconnections. This could potentially result into a significant change in ablation strategy and possibly to increased success rate following pulmonary vein isolation.

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References

  1. Nery PB, Belliveau D, Nair GM, Bernick J, Redpath CJ, Szczotka A, et al. Relationship Between Pulmonary Vein Reconnection and Atrial Fibrillation Recurrence: A Systematic Review and Meta-Analysis. JACC Clin Electrophysiol. 2016;2:474–83.

    Article  Google Scholar 

  2. Morillo CA, Verma A, Connolly SJ, Kuck KH, Nair GM, Champagne J, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA. 2014;311:692–700.

    Article  CAS  Google Scholar 

  3. Lin D, Santangeli P, Zado ES, et al. Electrophysiologic findings and long-term outcomes in patients undergoing third or more catheter ablation procedures for atrial fibrillation. J Cardiovasc Electrophysiol. 2015;26:371–7.

    Article  Google Scholar 

  4. Kuck KH, Hoffmann BA, Ernst S, et al. Impact of Complete Versus Incomplete Circumferential Lines Around the Pulmonary Veins During Catheter Ablation of Paroxysmal Atrial Fibrillation: Results From the Gap-Atrial Fibrillation-German Atrial Fibrillation Competence Network 1 Trial. Circ Arrhythm Electrophysiol. 2016;9:e003337.

    Article  Google Scholar 

  5. Nanthakumar K, Plumb VJ, Epstein AE, Veenhuyzen GD, Link D, Kay GN. Resumption of electrical conduction in previously isolated pulmonary veins: rationale for a different strategy? Circulation. 2004;109:1226–9.

    Article  Google Scholar 

  6. Hussein A, Das M, Riva S, et al. Use of Ablation Index-Guided Ablation Results in High Rates of Durable Pulmonary Vein Isolation and Freedom From Arrhythmia in Persistent Atrial Fibrillation Patients. Circ Arrhythm Electrophysiol. 2018;11:e006576.

    Article  Google Scholar 

  7. Hutchinson MD, Garcia FC, Mandel JE, Elkassabany N, Zado ES, Riley MP, et al. Efforts to enhance catheter stability improve atrial fibrillation ablation outcome. Heart Rhythm. 2013;10:347–53.

    Article  Google Scholar 

  8. Park CI, Lehrmann H, Keyl C, et al. Mechanisms of pulmonary vein reconnection after radiofrequency ablation of atrial fibrillation: the deterministic role of contact force and interlesion distance. J Cardiovasc Electrophysiol. 2014;25:701–8.

    Article  Google Scholar 

  9. Piorkowski C, Eitel C, Rolf S, Bode K, Sommer P, Gaspar T, et al. Steerable versus non steerable sheath technology in atrial fibrillation ablation: a prospective, randomized study. Circ Arrhythm Electrophysiol. 2011;4:157–65.

    Article  Google Scholar 

  10. Chen S, Meng W, Sheng He D, et al. Blocking the pulmonary vein to left atrium conduction in addition to the entrance block enhances clinical efficacy in atrial fibrillation ablation. Pacing Clin Electrophysiol. 2012;35:524–31.

    Article  Google Scholar 

  11. Anter E, Contreras-Valdes FM, Shvilkin A, Tschabrunn CM, Josephson ME. Acute pulmonary vein reconnection is a predictor of atrial fibrillation recurrence following pulmonary vein isolation. J Interv Card Electrophysiol. 2014;39:225–32.

    Article  Google Scholar 

  12. Porta-Sánchez A, Magtibay K, Nayyar S, Bhaskaran A, Lai PFH, Massé S, et al. Omnipolarity applied to equi-spaced electrode array for ventricular tachycardia substrate mapping. Europace. 2019;21:813–21.

    Article  Google Scholar 

  13. Kanamori N, Kato T, Sakagami S, Saeki T, Kato C, Kawai K, et al. Optimal lesion size index to prevent conduction gap during pulmonary vein isolation. J Cardiovasc Electrophysiol. 2018;29:1616–23.

    Article  Google Scholar 

  14. Whitaker J, Fish J, Harrison J, et al. Lesion Index-Guided Ablation Facilitates Continuous, Transmural, and Durable Lesions in a Porcine Recovery Model. Circ Arrhythm Electrophysiol. 2018;11:e005892.

    Article  Google Scholar 

  15. Mattia L, Crosato M, Indiani S, Causin E, Licciardello C, Maria Squasi PA, et al. Prospective Evaluation of Lesion Index-Guided Pulmonary Vein Isolation Technique in Patients with Paroxysmal Atrial Fibrillation: 1-year Follow-Up. J Atr Fibrillation. 2018;10:1858.

    Article  Google Scholar 

  16. Lin C-Y, Te ALD, Lin Y-J, et al. High-resolution mapping of pulmonary vein potentials improved the successful pulmonary vein isolation using small electrodes and inter-electrode spacing catheter. Int J Cardiol. 2018;272:90–6.

    Article  Google Scholar 

  17. Anter E, Tschabrunn CM, Josephson ME. High-Resolution Mapping of Scar-Related Atrial Arrhythmias Using Smaller Electrodes With Closer Interelectrode Spacing. Circ Arrhythm Electrophysiol. 2015;8:537–45.

    Article  Google Scholar 

  18. Masuda M, Fujita M, Iida O, Okamoto S, Ishihara T, Nanto K, et al. The identification of conduction gaps after pulmonary vein isolation using a new electroanatomic mapping system. Heart Rhythm. 2017;14:1606–14.

    Article  Google Scholar 

  19. Tedrow UB, Stevenson WG. Recording and interpreting unipolar electrograms to guide catheter ablation. Heart Rhythm. 2011;8:791–6.

    Article  Google Scholar 

  20. Iso K, Watanabe I, Kogawa R, Okumura Y, Nagashima K, Takahashi K, et al. Wavefront direction and cycle length affect left atrial electrogram amplitude. J Arrhythm. 2017;33:269–74.

    Article  Google Scholar 

  21. Garcia-Bolao I, Ballesteros G, Ramos B, et al. Identification of pulmonary vein reconnection gaps with high-density mapping in redo atrial fibrillation procedures. Europace. 2018;20:f351–8.

    Article  Google Scholar 

  22. McGarry TJ, Narayan SM. The Anatomical Basis of Pulmonary Vein Reconnection After Ablation for Atrial Fibrillation: Wounds That Never Felt a Scar? J Am Coll Cardiol. 2012;59:939–41.

    Article  Google Scholar 

  23. Kowalski M, Grimes MM, Perez FJ, Kenigsberg DN, Koneru J, Kasirajan V, et al. Histopathologic Characterization of Chronic Radiofrequency Ablation Lesions for Pulmonary Vein Isolation. J Am Coll Cardiol. 2012;59:930–8.

    Article  Google Scholar 

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Authors and Affiliations

  1. Electrophysiology Department, Barts Heart Centre, St. Bartholomew’s Hospital, London, UK

    Nikolaos Papageorgiou, Nabeela Karim, Jason Garcia, Antonio Creta, Richard Ang, Neil Srinivasan, Rui Providencia, Ross J. Hunter, Mehul Dhinoja, Vivienne Ezzat, Vinit Sawhney, Adam Dennis, Martin Lowe, Pier D. Lambiase & Anthony W. C. Chow

  2. Institute of Cardiovascular Science, University College London, London, UK

    Nikolaos Papageorgiou & Pier D. Lambiase

  3. Cardiovascular Department of Abbott, London, UK

    James Williams

  4. Institute of Health Informatics, University College London, London, UK

    Rui Providencia

  5. Queen Mary University, London, UK

    Anthony W. C. Chow

Authors
  1. Nikolaos Papageorgiou
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  2. Nabeela Karim
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  3. James Williams
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  4. Jason Garcia
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  5. Antonio Creta
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  6. Richard Ang
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  7. Neil Srinivasan
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  8. Rui Providencia
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  9. Ross J. Hunter
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  10. Mehul Dhinoja
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  13. Adam Dennis
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  14. Martin Lowe
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  16. Anthony W. C. Chow
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Corresponding author

Correspondence to Anthony W. C. Chow.

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Dr Chow receives research grant funding from Abbott and Boston Scientific Inc.

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Papageorgiou, N., Karim, N., Williams, J. et al. Initial experience of the High-Density Grid catheter in patients undergoing catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 63, 259–266 (2022). https://doi.org/10.1007/s10840-021-00950-y

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  • DOI: https://doi.org/10.1007/s10840-021-00950-y

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