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Clinical impact of high-density mapping on the acute and long term outcome of atypical atrial flutter ablations

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Abstract

Purpose

We evaluated the clinical impact of the high-density (HD) mapping compared with the standard low-density (LD) ablation catheter mapping technique in the treatment of AFLs.

Methods

We retrospectively evaluated short and long outcomes of patients approached with an HD and a LD electro-anatomical strategy for atypical AFLs.

Results

Eighty-seven patients were included. Patients were almost male (60%), relatively old (65 ± 8 years), with a moderate CHA2DS2Vasc score (2.3 ± 1.3), a preserved ejection fraction (58 ± 6), and moderate atrial dilatation (44 ± 7 mm). Baseline clinical characteristics were comparable between groups (p = NS). Among AFLs, 10 (11%) were located in the right and 78 (89%) in the left atrium, including 22 (28%) roof dependent and 37 (47%) mitral dependent (p = NS). Sinus rhythm restoration during ablation was more frequently observed in the HD group (79% vs 56%, p = 0.037), without differences in mapping time, procedural time, and radiological dose (p = NS). Overall AFL/AT/AF recurrence rate at 1, 2, and 3 years was lower in the HD group (14% vs 37% p = 0.02, 14% vs 48% p = 0.002 and 14% vs 50% p < 0.001, respectively) with a time-dependent trend only in the LD group (37% vs 48% vs 50% at 1, 2, and 3 years respectively, p = 0.059). HD mapping (OR 0.17; 95% CI 0.04–0.66) and younger age (OR 1.09; 95% CI 1.01–1.19) resulted independent predictors of overall arrhythmias at follow-up.

Conclusions

Short- and long-term outcomes of atypical AFL ablation were better in the case of HD mapping, which resulted independent predictor of arrhythmia recurrences.

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Data availability

Data collected using the Estensa Software in use at the Azienda Ospedaliero Universitaria Pisana, University Hospital of Pisa.

Code availability

Not available.

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Acknowledgements

We thank Irene Celin (Abbott Medical, Italia), Andrea Vannozzi (Byosense Webster, Italia) and Mauro Bura (Boston Scientific, Italia) for the technical support.

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Authors and Affiliations

  1. Second Division of Cardiology, Cardiac-Toracic and Vascular Department, AOUP, New Santa Chiara Hospital, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    Andrea Di Cori, Lorenzo Mazzocchetti, Matteo Parollo, Mario Giannotti, Antonio Canu, Valentina Barletta, Salvatore della Volpe, Raffaele De Lucia, Stefano Viani, Luca Segreti, Ezio Soldati, Giulio Zucchelli & Maria Grazia Bongiorni

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  1. Andrea Di Cori
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  2. Lorenzo Mazzocchetti
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Contributions

All authors contributed to the study conception and design. All authors read and approved the final manuscript (see the attached file).

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Correspondence to Andrea Di Cori.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Di Cori, A., Mazzocchetti, L., Parollo, M. et al. Clinical impact of high-density mapping on the acute and long term outcome of atypical atrial flutter ablations. J Interv Card Electrophysiol 67, 43–51 (2024). https://doi.org/10.1007/s10840-022-01121-3

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  • DOI: https://doi.org/10.1007/s10840-022-01121-3

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