Repeat ablation using ultra-high-density mapping revealed higher pulmonary vein reconnection rates after index contact-force radiofrequency PVI compared to cryoballoon PVI (2.5 vs 1.4 PVs; P=0.0025).
Observational (n=50)
Does the index ablation modality (CF-RFC vs CB PVI) affect the pattern of pulmonary vein reconnection and atrial tachycardia mechanisms detected by ultra-high-density mapping during repeat ablation?
Ultra-high-density mapping during repeat ablation reveals distinct patterns of conduction gaps depending on the index PVI modality, with higher PV reconnection rates after CF-RFC compared to cryoballoon ablation.
Tasa de eventos absoluta: 2.5% vs 1.4%
valor p: p=.0025
INTRODUCTION: The aim of this study was to investigate electrophysiological findings in patients with arrhythmia recurrence undergoing a repeat ablation procedure using ultra-high-density (UHDx) mapping following an index procedure using either contact-force (CF)-guided radiofrequency current (RFC) pulmonary vein isolation (PVI) or second-generation cryoballoon (CB) PVI for treatment of atrial fibrillation (AF). METHODS AND RESULTS: Fifty consecutive patients with recurrence of AF and/or atrial tachycardia (AT) following index CF-RFC PVI (n = 21) or CB PVI (n = 29) were included. A 64-pole mini-basket mapping catheter in combination with an UHDx-mapping system-guided ablation was used. RFC was applied using a catheter tip with three incorporated mini-electrodes. PV reconnection rates were higher after CF-RFC PVI (CF-RFC: 2.5 ± 1.3 PVs vs CB: 1.4 ± 0.9 PVs; P = .0025) and left PVs were more frequently reconnected (CF-RFC: 64% PVs vs CB: 35% PVs; P = .0077). Fractionated signals along the antral index ablation line (FS) were found in 30% of CB-PVI patients (CF-RFC: 9.5% vs CB:30%; P = .098) targeted for ablation. In five cases, FS were a critical part of maintaining consecutive AT. The main AT mechanism found during reablation (n = 45 ATs) was macroreentry (80% 36/45, CF-RFC: 78.9% vs CB: 80.8%; P = 1.0) with a variety of circuits throughout both atria. CONCLUSION: UHDx mapping is sensitive in detecting conduction gaps along the index ablation line. Left PVs are more frequently reconnected after initial CF-RFC PVI. FS are a common finding after CB PVI and can maintain certain forms of ATs. ATs after index PVI are mostly macroreentries with a broad spectrum of entities.
Gunawardene et al. (Fri,) conducted a observational in Arrhythmia recurrence (atrial fibrillation and/or atrial tachycardia) following pulmonary vein isolation (n=50). Contact-force-guided radiofrequency current (CF-RFC) PVI (index procedure) vs. Second-generation cryoballoon (CB) PVI (index procedure) was evaluated on Pulmonary vein reconnection rates (mean number of reconnected PVs) (p=.0025). Repeat ablation using ultra-high-density mapping revealed higher pulmonary vein reconnection rates after index contact-force radiofrequency PVI compared to cryoballoon PVI (2.5 vs 1.4 PVs; P=0.0025).