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Electroanatomical mapping improves procedural outcomes of cryoballoon pulmonary vein isolation (the Achieve Plus study)

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Validation of pulmonary vein (PV) isolation (PVI) using only the Achieve catheter following cryoballoon ablation (CBA) is imperfect since pulmonary vein potentials (PVP) can be recorded in only 50–85% of the veins and residual PVP are found in up to 4.3–7.6% of the isolated veins in remapping studies.

Objective

To study if addition of electroanatomical mapping to Achieve catheter–guided CBA is superior for PVI.

Methods

One hundred patients were randomized between Achieve catheter–guided CBA (control group; N = 50) and Achieve catheter–guided CBA with additional EnSite voltage maps performed pre- and post-CBA (Achieve Plus group; N = 50). Confirmation of PVI was done by circular mapping catheter (CMC) and EnSite mapping by a second blinded operator.

Results

Despite apparent PVI in all PVs after CBA, incomplete PVI was present in 0 out of 50 patients (0%) and 0 out of 204 PVs in the Achieve Plus group versus 6 patients out of 50 (12%; P = 0.012) and 6 out of 203 PVs (3%; P = 0.013) in the control group. All 6 non-isolated PVs could be successfully isolated by additional cryoapplications. Procedure time was longer in the Achieve Plus group (75.76 ± 21.65 vs 66.06 ± 16.83 min; P = 0.014) with equal fluoroscopy times (14.85 ± 6.41 vs 14.33 ± 8.55; P = 0.732).

Conclusion

The addition of electroanatomical EnSite mapping to the Achieve catheter improves the PVI rate of CBA and could be considered for future use.

Graphical abstract

Design and Results of the Achieve Plus study. The Achieve Plus study shows that the addition of electro-anatomical EnSite mapping to the Achieve catheter improves PVI rate of CBA and could be considered for future use. See text for further explanation. Abbreviations: CBA: cryoballoon ablation; PVI: pulmonary vein isolation.

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Data and/or Code availability

The authors confirm that the data supporting the findings of this study are available within the article. The study data are available from the corresponding author, YDG, upon reasonable request.

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Author notes

  1. V. Varnavas and M. Wolf contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium

    Yves De Greef, M. Tijskens, D. Sofianos, F. Cecchini, J. De Cocker & M. Wolf

  2. Heart Rhythm Management Centre, University Hospital Brussels, Brussels, Belgium

    Yves De Greef, D. Sofianos & F. Cecchini

  3. Department of Cardiology, ULB Erasmus Hospital, Brussels, Belgium

    J. P. Abugattas De Torres

  4. Department of Cardiology, OLV Hospital Alost, Aalst, Belgium

    K. De Schouwer

  5. Department of Cardiology, Heart Centre AZ Sint Jan, Brugge, Belgium

    I. Buysschaert

  6. Department of Cardiology, University Hospital Saint-Luc UCL, Brussels, Belgium

    V. Varnavas

Authors
  1. Yves De Greef
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  2. M. Tijskens
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Y. De Greef, M. Tijskens, I. Buysschaert, and J. P. Abugattas de Torres. The first draft of the manuscript was written by Y. De Greef and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yves De Greef.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Medical Ethics Committee ZNA, Institutional Review Board-ZNA/OCMW Antwerp, Lindendreef 1, 2020 Antwerp (E.C. Approval No. 5482).

Consent to participate and/or consent for publication

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

Competing interests

The authors declare no competing interests.

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De Greef, Y., Tijskens, M., De Torres, J.P.A. et al. Electroanatomical mapping improves procedural outcomes of cryoballoon pulmonary vein isolation (the Achieve Plus study). J Interv Card Electrophysiol 66, 923–930 (2023). https://doi.org/10.1007/s10840-022-01384-w

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  • DOI: https://doi.org/10.1007/s10840-022-01384-w

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