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

• Published in: International journal of cardiology 2018-11, Vol.270, p.136-142
• Main Authors: Conte, Giulio, Soejima, Kyoko, de Asmundis, Carlo, Chierchia, Gian-Battista, Badini, Matteo, Miwa, Yosuke, Caputo, Maria Luce, Özkartal, Tardu, Maffessanti, Francesco, Sieira, Juan, Degreef, Yves, Stroker, Erwin, Regoli, François, Moccetti, Tiziano, Brugada, Pedro, Auricchio, Angelo
• Format: Article
• Language: English
• Subjects: Ablation; Adult; Aged; Atrial fibrillation; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - surgery; Catheter Ablation - methods; Catheter Ablation - standards; Cryoballoon; Cryosurgery - methods; Cryosurgery - standards; Echocardiography - methods; Echocardiography - standards; Echocardiography, Transesophageal - methods; Echocardiography, Transesophageal - standards; Female; Follow-Up Studies; High-resolution mapping; Humans; Male; Middle Aged; Pulmonary vein isolation; Pulmonary Veins - diagnostic imaging; Pulmonary Veins - surgery
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2018.05.135

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. 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. 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 0.5 mV. A total of 29 patients (88%) remained free of symptomatic AF during a mean follow-up of 13.2 ± 3.7 months. 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. •Unrecognized incomplete PVI may be responsible for clinical recurrences of AF.•Identification of incomplete acute efficacy of PVI is clinically relevant.•Atrial high-resolution mapping enables accurate detection of incomplete CB-PVI.•Atrial high-resolution mapping characterizes the extension of cryoablation.•High-resolution mapping identifies abolishment by CB of non-PVI related sources of AF.