BACKGROUND: The study is intended to evaluate the acute and long-term effectiveness and peri-procedural safety in ablation of persistent atrial fibrillation (PsAF) using the CartoFinder algorithm guided ablation (CFGA) targeting on repetitive activation patterns (RAPs) and focal impulses (FIs) identified in dynamic maps. METHODS: This is a prospective, single-arm, multicenter study. A 64-pole multielectrode basket catheter was used for intracardiac global electrogram (EGM) mapping. The RAPs or FIs were repeatedly mapped and ablated for up to five iterations by the CartoFinder algorithm to achieve sinus rhythm (SR) or organized atrial tachycardia (AT), which were followed by PVI. All patients were followed up for 12 months after procedure. RESULTS: Sixty-four PsAF patients (age, 60.7 ± 9.1 years; male, 76.6%; median PsAF duration, 6.0 months) underwent CFGA on RAPs/FIs. Six patients (9.4%) reported primary adverse event (PAE) including groin hematoma (2), complete heart block (1), tamponade (1), pericarditis (1), and pseudoaneurysm (1). Repeated mapping and ablation on RAPs/FIs resulted in the cycle length (CL) increase from 191.0 ± 167.6 ms at baseline to 365.7 ± 296.7 ms in the LA and from 167.8 ± 41.6 ms to 379.4 ± 293.5 ms in the RA and 30.2% (19/63) AF termination to SR or organized AT. The 12-month arrhythmia-free and symptomatic AF-free rates were 60.9% and 75.0%, respectively. Patients with acute AF termination showed a higher 12-month arrhythmia-free rate (76.9%) than those without (50.0%, p = .04). CONCLUSIONS: The study demonstrated that the CartoFinder algorithm can be used for global activation mapping during PsAF ablation. Patients with acute AF termination had a lower 12-month AF recurrence rate compared to patients without.

Cardiology Department AZ Sint Jan Bruges Belgium

Cardiology Department OLV Hospital Aalst Belgium

Cardiology Department Universitair Ziekenhuis Antwerpen Edegem Belgium

Ceske Budejovice Hospital Ceske Budejovice Czech Republic

Faculty of Health and Social Sciences University of South Bohemia in Ceske Budejovice Ceske Budejovice Czech Republic

University of Antwerp Antwerpen Belgium

Zobrazit více v PubMed

Andrade JG, Champagne J, Dubuc M, et al. Cryoballoon or radiofrequency ablation for atrial fibrillation assessed by continuous monitoring: a randomized clinical trial. Circulation. 2019;140:1779-1788.

Duytschaever M, De Pooter J, Demolder A, et al. Long-term impact of catheter ablation on arrhythmia burden in low-risk patients with paroxysmal atrial fibrillation: the close to cure study. Heart Rhythm. 2020;17:535-543.

Duytschaever M, Vijgen J, De Potter T, et al. Standardized pulmonary vein isolation workflow to enclose veins with contiguous lesions: the multicentre vistax trial. Europace. 2020;22:1645-1652.

Kautzner J, Albenque JP, Natale A, et al. A novel temperature-controlled radiofrequency catheter ablation system used to treat patients with paroxysmal atrial fibrillation. JACC Clin Electrophysiol. 2021;7:352-363.

Schilling R, Dhillon GS, Tondo C, Riva S, Grimaldi M. Safety, effectiveness, and quality of life following pulmonary vein isolation with a multi-electrode radiofrequency balloon catheter in paroxysmal atrial fibrillation: 1-year outcomes from shine. Europace. 2021;23:851-860.

Calkins H, Hindricks G, Cappato R, et al. 2017 hrs/ehra/ecas/aphrs/solaece expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018;20:e1.

Wokhlu A, Hodge DO, Monahan KH, et al. Long-term outcome of atrial fibrillation ablation: impact and predictors of very late recurrence. J Cardiovasc Electrophysiol. 2010;21:1071-1078.

Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372:1812-1822.

Mansour M, Calkins H, Osorio J, et al. Persistent atrial fibrillation ablation with contact force-sensing catheter: the prospective multicenter precept trial. JACC Clin Electrophysiol. 2020;6:958-969.

Margulescu AD, Mont L. Persistent atrial fibrillation vs paroxysmal atrial fibrillation: differences in management. Expert Rev Cardiovasc Ther. 2017;15:601-618.

Daoud EG, Zeidan Z, Hummel JD, et al. Identification of repetitive activation patterns using novel computational analysis of multielectrode recordings during atrial fibrillation and flutter in humans. JACC Clin Electrophysiol. 2017;3:207-216.

Honarbakhsh S, Schilling RJ, Dhillon G, et al. A novel mapping system for panoramic mapping of the left atrium: application to detect and characterize localized sources maintaining atrial fibrillation. JACC Clin Electrophysiol. 2018;4:124-134.

Narayan SM, Baykaner T, Clopton P, et al. Ablation of rotor and focal sources reduces late recurrence of atrial fibrillation compared with trigger ablation alone: extended follow-up of the confirm trial (conventional ablation for atrial fibrillation with or without focal impulse and rotor modulation). J Am Coll Cardiol. 2014;63:1761-1768.

Wolf M, Tavernier R, Zeidan Z, et al. Identification of repetitive atrial activation patterns in persistent atrial fibrillation by direct contact high-density electrogram mapping. J Cardiovasc Electrophysiol. 2019;30:2704-2712.

Honarbakhsh S, Schilling RJ, Providencia R, et al. Automated detection of repetitive focal activations in persistent atrial fibrillation: validation of a novel detection algorithm and application through panoramic and sequential mapping. J Cardiovasc Electrophysiol. 2019;30:58-66.

Chang TY, Lin CY, Lin YJ, et al. Long-term outcome of patients with long-standing persistent atrial fibrillation undergoing ablation guided by a novel high-density panoramic mapping system: a propensity score matching study. Heart Rhythm O2. 2022;3:269-278.

Unland R, Bergau L, El Hamriti M, Guckel D, Piran M. Find me if you can: first clinical experience using the novel cartofinder algorithm in a routine workflow for atrial fibrillation ablation. J Clin Med. 2021;10:2979.

Narayan SM, Krummen DE, Shivkumar K, Clopton P, Rappel WJ, Miller JM. Treatment of atrial fibrillation by the ablation of localized sources: confirm (conventional ablation for atrial fibrillation with or without focal impulse and rotor modulation) trial. J Am Coll Cardiol. 2012;60:628-636.

Takahashi Y, O'Neill MD, Hocini M, et al. Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation. J Am Coll Cardiol. 2008;51:1003-1010.

Kochhäuser S, Jiang CY, Betts TR, et al. Impact of acute atrial fibrillation termination and prolongation of atrial fibrillation cycle length on the outcome of ablation of persistent atrial fibrillation: a substudy of the star af ii trial. Heart Rhythm. 2017;14:476-483.

Deshmukh A, Patel NJ, Pant S, et al. In-hospital complications associated with catheter ablation of atrial fibrillation in the united states between 2000 and 2010: analysis of 93 801 procedures. Circulation. 2013;128:2104-2112.

Chinitz L, Inoue K, Hikoso S, et al. Pulmonary vein isolation alone vs. More extensive ablation with defragmentation and linear ablation of persistent atrial fibrillation: the earnest-pvi trial. J Cardiovasc Electrophysiol. 2021;23:565-574.

Kristler P. The Addition of Posterior Wall Isolation (PWI) Does Not Improve Arrhythmia Outcomes Compared with Pulmonary Vein Isolation (PVI) Alone in Patients Undergoing First Time Ablation for Persistent Atrial Fibrillation (AF). ESC 2022 Congress, Barcelona Spain; 2022.

Jiang X, Liao J, Ling Z, et al. Adjunctive left atrial posterior wall isolation in treating atrial fibrillation: insight from a large secondary analysis. JACC Clin Electrophysiol. 2022;8:605-618.

Lee JM, Shim J, Park J, et al. The electrical isolation of the left atrial posterior wall in catheter ablation of persistent atrial fibrillation. JACC Clin Electrophysiol. 2019;5:1253-1261.

Inoue K, Hikoso S, Masuda M, et al. Pulmonary vein isolation alone vs. More extensive ablation with defragmentation and linear ablation of persistent atrial fibrillation: the earnest-pvi trial. Europace. 2021;23:565-574.

Yang G, Zheng L, Jiang C, et al. Circumferential pulmonary vein isolation plus low-voltage area modification in persistent atrial fibrillation: the stable-sr-ii trial. JACC Clin Electrophysiol. 2022;8:882-891.

Huo Y, Gaspar T, Schönbauer R, et al. Low-voltage myocardium-guided ablation trial of persistent atrial fibrillation. NEJM Evidence. 2022;1:EVIDoa2200141.

Zaman JAB, Sauer WH, Alhusseini MI, et al. Identification and characterization of sites where persistent atrial fibrillation is terminated by localized ablation. Circ Arrhythm Electrophysiol. 2018;11:e005258.

Halbfass P, Muller P, Nentwich K, et al. Repetitive atrial activation during ongoing atrial fibrillation-comparison using different mapping algorithms: preliminary findings. J Interv Card Electrophysiol. 2017;49:67-74.

Lau DH, Linz D, Schotten U, Mahajan R, Sanders P, Kalman JM. Pathophysiology of paroxysmal and persistent atrial fibrillation: rotors, foci and fibrosis. Heart Lung Circ. 2017;26:887-893.

Sarkozy A, Vijgen J, De Potter T, Schilling R, Markides V. An early multicenter experience of the novel high-density star-shaped mapping catheter in complex arrhythmias. J Interv Card Electrophysiol. 2022;64:223-232.

Steinfurt J, Dall'Aglio PB, Hugenschmidt J, et al. Initial clinical experience with a novel 8-spline high-resolution mapping catheter. Jacc Clin Electrophysiol. 2022;8:1067-1076.