Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov 1:270:136-142.
doi: 10.1016/j.ijcard.2018.05.135. Epub 2018 Jun 1.

Value of high-resolution mapping in optimizing cryoballoon ablation of atrial fibrillation

Giulio Conte  1 , Kyoko Soejima  2 , Carlo de Asmundis  3 , Gian-Battista Chierchia  3 , Matteo Badini  4 , Yosuke Miwa  2 , Maria Luce Caputo  4 , Tardu Özkartal  4 , Francesco Maffessanti  5 , Juan Sieira  3 , Yves Degreef  3 , Erwin Stroker  3 , François Regoli  4 , Tiziano Moccetti  4 , Pedro Brugada  3 , Angelo Auricchio  6
Affiliations

Value of high-resolution mapping in optimizing cryoballoon ablation of atrial fibrillation

Giulio Conte et al. Int J Cardiol. .

Abstract

Background: Unrecognized incomplete pulmonary vein isolation (PVI), as opposed to post-PVI pulmonary vein reconnection, may be responsible for clinical recurrences of atrial fibrillation (AF). To date, no data are available on the use of high-resolution mapping (HRM) during cryoballoon (CB) ablation for AF as the index procedure. The aims of this study were: - to assess the value of using a HRM system during CB ablation procedures in terms of ability in acutely detecting incomplete CB lesions; - to compare the 8-pole circular mapping catheter (CMC, Achieve) and the 64-pole mini-basket catheter (Orion) with respect to pulmonary vein (PV) signals detection at baseline and after CB ablation; - to characterize the extension of the lesion produced by CB ablation by means of high-density voltage mapping.

Methods: Consecutive patients with drug-resistant paroxysmal or early-persistent AF undergoing CB ablation as the index procedure, assisted by a HRM system, were retrospectively included in this study.

Results: A total of 33 patients (25 males; mean age: 59 ± 18 years, 28 paroxysmal AF) were included. At baseline, CMC catheter revealed PV activity in 102 PVs (77%), while the Orion documented PV signals in all veins (100%). Failure of complete CB-PVI was more frequently revealed by atrial re-mapping with the Orion as compared to the Achieve catheter (24% vs 0%, p < 0.05). A repeat ablation was performed in 8 patients (24%). In 9% of cases, the Orion catheter detected far-field signals originating from the right atrium. Quantitative assessment of the created lesion revealed a significant reduction of the left atrial area having voltage >0.5 mV. A total of 29 patients (88%) remained free of symptomatic AF during a mean follow-up of 13.2 ± 3.7 months.

Conclusion: Atrial re-mapping after CB ablation by means of a HRM system improves the detection of areas of incomplete ablation, characterizes the extension of the cryo-ablated tissue and can identify abolishment of potential non-PVI related sources of AF.

Keywords: Ablation; Atrial fibrillation; Cryoballoon; High-resolution mapping; Pulmonary vein isolation.

PubMed Disclaimer

Comment in

LinkOut - more resources