QDOT MICRO catheter guided modified stepwise method increased mitral isthmus block rate after single endocardial ablation line to 90.6% versus 69.4% with STSF catheter in patients with persistent atrial fibrillation.
RCT (n=68)
Open-label
Numerical table method
No
Does a modified stepwise ablation method guided by the QDOT MICRO catheter improve procedural efficiency and mitral isthmus block rates compared to a standard STSF catheter stepwise method in patients with persistent atrial fibrillation?
Using the QDOT MICRO catheter to map the vein of Marshall potential from the endocardium facilitates precise mitral isthmus ablation, significantly improving endocardial block rates and reducing the need for epicardial ablation in patients with persistent atrial fibrillation.
Estimación del efecto: P=0.019
Tasa de eventos absoluta: 90.6% vs 69.4%
valor p: p=0.019
Background Ethanol infusion of the vein of Marshall (EI-VOM) has elevated the success rate of mitral isthmus (MI) block in patients with persistent atrial fibrillation (PeAF). However, the procedure involve the extensive endocardial ablation and epicardial ablation, which brought the operational difficulty and risk. Material and methods Patients with PeAF were randomly assigned in a 1:1 ratio to either STSF catheter group using the stepwise method (STSF group) or QDM catheter group using a modified stepwise method (QDM group) for MI ablation. The modified stepwise method was as follows: step 1, The potential of VOM was mapped from endocardium using the QDM catheter. Step 2, EI-VOM. Step 3, precise endocardial ablation guiding by VOM potential. Step 4, QDM catheter was cannulated into the CS for epicardial ablation, especially the ostium of Marshall. The immediate procedural results were compared between the two groups. Results After excluding 5 patients with unsuccessful EI-VOM, 68 patients were divided into STSF group (36 cases) and QDM group (32 cases). The potential of VOM could be clearly mapped from endocardium using a QDM catheter. Both the accumulated operation time ( p = 0.032) and ablation time ( p 0.001) were significantly shorter in the QDM group compared to the STSF group. QDM group achieved more conduction blocks of MI after a single endocardial line ablation (71.9% vs. 36.1%, p = 0.017) with fewer ablation points ( p 0.001) compared to the STSF group. The block rate of the MI after endocardial ablation alone was also higher in the QDM group than in the STSF group (90.6% vs. 69.4%; P = 0.019), which avoided epicardial ablation. Even if epicardial ablation is necessary, the number of ablation points on the epicardial surface in the QDM group would be fewer than in the STSF group ( p 0.001). Conclusions The QDM catheter can be used to map the potential of VOM from endocardium, thereby facilitating precise endocardial mitral isthmus linear ablation. The modified stepwise approach effectively reduces the number of endocardial ablation points and the likelihood of requiring epicardial ablation. (NCT06145906, ClinicalTrial.gov).
Li et al. (Thu,) conducted a rct in Adults aged 18-75 years with persistent atrial fibrillation for more than 1 year undergoing first-time catheter ablation (n=68). QDOT MICRO catheter using a modified stepwise method for mitral isthmus ablation vs. STSF ablation catheter using the stepwise method was evaluated on Achievement of bidirectional mitral isthmus (MI) conduction block after ablation (P=0.019, p=0.019). QDOT MICRO catheter guided modified stepwise method increased mitral isthmus block rate after single endocardial ablation line to 90.6% versus 69.4% with STSF catheter in patients with persistent atrial fibrillation.