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High-density mapping improves detection of conduction gaps after pulmonary vein isolation ablation with a circular mapping catheter

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Abstract

Background

High-density (HD) mapping of the pulmonary vein (PVs) has been hypothesized to improve the detection of conduction gaps in the radiofrequency ablation lesions set after pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF). We aimed to compare the incidence of gaps after PVI with a standard 20-pole circumferential mapping catheter (CMC-20) and an HD mapping catheter (HD Grid).

Methods

This prospective study included patients scheduled for high-power short-duration PVI. Acute PVI was defined as an entrance and exit block using the CMC-20 after ≥ 20 min waiting period. The left atrium was then remapped using the HD Grid high-density mapping catheter to identify residual conduction gaps in the PVI lines by voltage and activation criteria. The primary endpoint was the number of gaps identified per patient by the HD Grid catheter.

Results

A total of 20 patients were included (mean age 59.9 ± 10.8 years, 15% female, 70% paroxysmal AF). The new map with the HD Grid identified 6 gaps in 4 patients (20%) or 0.3 ± 0.7 gaps per patient (p = 0.055 when compared to CMC-20). Five gaps (83%) were located at the right PVs. There was no difference in mapping time (CMC-20 12.2 ± 2.6 min vs HD Grid 11.7 ± 3.4 min, p = 0.452); however, the number of points was significantly higher in the HD Grid map (1662.7 ± 366.1 vs 1171.6 ± 313.6, p < 0.001).

Conclusions

HD mapping during AF ablation identified PVI gaps in 1 out of 5 patients. Therefore, HD mapping may have the potential to improve AF ablation success rates in the long term.

Trial registration

ClinicalTrials.gov NCT04850508 on April 20, 2021.

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Abbreviations

AF:

Atrial fibrillation

CMC-20:

20-Pole circumferential mapping catheter

DOAC:

Direct oral anticoagulant

ECG:

Electrocardiogram

HD:

High-density

HPSD:

High-power short-duration

IQR:

Interquartile range

LA:

Left atrium

LAT:

Local activation timing

LIPV:

Left inferior pulmonary vein

LSPV:

Left superior pulmonary vein

MRI:

Magnetic resonance imaging

PV:

Pulmonary vein

PVI:

Pulmonary vein isolation

SD:

Standard deviation

RSPV:

Right superior pulmonary vein

RIPV:

Right inferior pulmonary vein

TEE:

Transesophageal echocardiogram

TTE:

Transthoracic echocardiogram

References

  1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J 2020. https://doi.org/10.1093/eurheartj/ehaa612

  2. Kuck KH, Albenque JP, Chun KJ, Furnkranz A, Busch M, Elvan A, et al. Repeat ablation for atrial fibrillation recurrence post cryoballoon or radiofrequency ablation in the FIRE AND ICE trial. Circ Arrhythm Electrophysiol. 2019;12(6):e007247. https://doi.org/10.1161/CIRCEP.119.007247.

    Article  CAS  PubMed  Google Scholar 

  3. Kuck KH, Brugada J, Furnkranz A, Metzner A, Ouyang F, Chun KR, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016;374(23):2235–45. https://doi.org/10.1056/NEJMoa1602014.

    Article  PubMed  Google Scholar 

  4. Ravi V, Poudyal A, Abid QU, Larsen T, Krishnan K, Sharma PS, et al. High-power short duration vs. conventional radiofrequency ablation of atrial fibrillation: a systematic review and meta-analysis. Europace : Eur Pacing Arrhythmias Card Electrophysiol : J Work Groups Card Pacing Arrhythmias Cardiac Cell Electrophysiol Eur Soc Cardiol. 2021;23(5):710–21. https://doi.org/10.1093/europace/euaa327.

    Article  Google Scholar 

  5. Phlips T, Taghji P, El Haddad M, Wolf M, Knecht S, Vandekerckhove Y, et al. Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the ’CLOSE’-protocol. Eur : Eur Pacing Arrhythmias Card Electrophysiol : J Work Groups Card Pacing Arrhythmias Card Cell Electrophysiol Eur Soc Cardiol. 2018;20(FI_3):f419–27. https://doi.org/10.1093/europace/eux376.

    Article  Google Scholar 

  6. Garcia-Bolao I, Ramos P, Ballesteros G, Vives E. New mapping tools to assess lesion in atrial fibrillation. Eur : Eur Pacing Arrhythmias Card Electrophysiol: J Work Groups Card Pacing Arrhythmias Card Cell Electrophysiol Eur Soc Cardiol. 2019;21(Supplement_3):iii2–4. https://doi.org/10.1093/europace/euz110.

    Article  Google Scholar 

  7. Takigawa M, Relan J, Kitamura T, Martin CA, Kim S, Martin R, et al. Impact of spacing and orientation on the scar threshold with a high-density grid catheter. Circ Arrhythm Electrophysiol. 2019;12(9):e007158. https://doi.org/10.1161/CIRCEP.119.007158.

    Article  PubMed  Google Scholar 

  8. Porterfield C, Gora PJ, Wystrach A, Rossi P, Rillo M, Sebag FA, et al. Confirmation of pulmonary vein isolation with high-density mapping: comparison to traditional workflows. J Atr Fibrillation. 2020;12(6):2361. https://doi.org/10.4022/jafib.2361.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bourier F, Duchateau J, Vlachos K, Lam A, Martin CA, Takigawa M, et al. High-power short-duration versus standard radiofrequency ablation: insights on lesion metrics. J Cardiovasc Electrophysiol. 2018;29(11):1570–5. https://doi.org/10.1111/jce.13724.

    Article  PubMed  Google Scholar 

  10. Papageorgiou N, Karim N, Williams J, Garcia J, Creta A, Ang R, et al. Initial experience of the high-density grid catheter in patients undergoing catheter ablation for atrial fibrillation. J Interv Card Electrophysiol. 2022;63(2):259–66. https://doi.org/10.1007/s10840-021-00950-y.

    Article  PubMed  Google Scholar 

  11. Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659–66. https://doi.org/10.1056/NEJM199809033391003.

    Article  CAS  PubMed  Google Scholar 

  12. Hansom SP, Alqarawi W, Birnie DH, Golian M, Nery PB, Redpath CJ, et al. High-power, short-duration atrial fibrillation ablation compared with a conventional approach: Outcomes and reconnection patterns. J Cardiovasc Electrophysiol. 2021;32(5):1219–28. https://doi.org/10.1111/jce.14989.

    Article  PubMed  Google Scholar 

  13. Bologna F, Bordignon S, Perrotta L, Dugo D, Nagase T, Chen S, et al. Incidence and pattern of conduction gaps after pulmonary vein isolation with the endoscopic ablation system. J Interv Card Electrophysiol. 2020;57(3):465–71. https://doi.org/10.1007/s10840-019-00556-5.

    Article  PubMed  Google Scholar 

  14. Nair GM, Yeo C, MacDonald Z, Ainslie MP, Alqarawi WA, Nery PB, et al. Three-year outcomes and reconnection patterns after initial contact force guided pulmonary vein isolation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2017;28(9):984–93. https://doi.org/10.1111/jce.13280.

    Article  PubMed  Google Scholar 

  15. Nakamura K, Sasaki T, Minami K, Take Y, Inoue M, Sasaki W, et al. Prevalence, characteristics, and predictors of endocardial and nonendocardial conduction gaps during local impedance-guided extensive pulmonary vein isolation of atrial fibrillation with high-resolution mapping. J Cardiovasc Electrophysiol. 2021;32(8):2045–59. https://doi.org/10.1111/jce.15152.

    Article  PubMed  Google Scholar 

  16. Garcia-Bolao I, Ballesteros G, Ramos P, Menendez D, Erkiaga A, Neglia R, et al. Identification of pulmonary vein reconnection gaps with high-density mapping in redo atrial fibrillation ablation procedures. Eur : Eur Pacing Arrhythmias Card Electrophysiol: J Work Groups Card Pacing Arrhythmias Card Cell Electrophysiol Eur Soc Cardiol. 2018;20(FI_3):f351–8. https://doi.org/10.1093/europace/eux184.

    Article  Google Scholar 

  17. Crandall B, Kanuri S, Cutler M, Osborn J, Miller J, Mallender C, et al. High power ultra short duration ablation with HD grid improves freedom from atrial fibrillation and redo procedures compared to circular Mapping Catheter. J Atr Fibrillation. 2020;13(2):2414. https://doi.org/10.4022/jafib.2414.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Abbott provided in-kind support, including the provision of HD Grid mapping catheters used in study procedures.

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Authors and Affiliations

  1. Foothills Medical Centre, Libin Cardiovascular Institute, University of Calgary, 1403–29 St. N.W, Calgary, T2N 2T9, Alberta, Canada

    Bert Vandenberk, F. Russell Quinn, Julie Barmby, Stephen B. Wilton & Vikas Kuriachan

  2. Department of Cardiology, University Hospitals Leuven, Louvain, Belgium

    Bert Vandenberk

Authors
  1. Bert Vandenberk
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  2. F. Russell Quinn
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  5. Vikas Kuriachan
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Corresponding author

Correspondence to Bert Vandenberk.

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Ethical approval

The study was approved by the University of Calgary’s Research Ethics Board.

Informed consent

Participants provided written informed consent.

Conflict of interest

SBW: Research grants from Abbott, Boston Scientific, Medtronic Canada; consulting from Boston Scientific, unrelated to the manuscript. VK has research support, honoraria, or Ad board from Medtronic, Servier, Novartis, BMS Pfizer, and Libin Cardiovascular Institute.

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Vandenberk, B., Quinn, F.R., Barmby, J. et al. High-density mapping improves detection of conduction gaps after pulmonary vein isolation ablation with a circular mapping catheter. J Interv Card Electrophysiol 66, 1401–1410 (2023). https://doi.org/10.1007/s10840-022-01434-3

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  • DOI: https://doi.org/10.1007/s10840-022-01434-3

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