Safety and efficacy of catheter ablation on patients with persistent atrial fibrillation by targeting repetitive activation patterns and focal impulses

Tom De Potter; Andrea Sarkozy; Mattias Duytschaever; Alan Bulava

doi:10.1111/pace.14708

May 20, 2023Pacing and Clinical ElectrophysiologyOpen Access

Safety and efficacy of catheter ablation on patients with persistent atrial fibrillation by targeting repetitive activation patterns and focal impulses

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Why the study?

The acute and long-term effectiveness and peri-procedural safety of persistent AF ablation guided by the CartoFinder algorithm targeting repetitive activation patterns and focal impulses needed evaluation.

Does CartoFinder algorithm guided ablation targeting repetitive activation patterns and focal impulses improve outcomes in patients with persistent atrial fibrillation?

Structured PICO

Does CartoFinder algorithm guided ablation targeting repetitive activation patterns and focal impulses improve outcomes in patients with persistent atrial fibrillation?

P

Population

64 patients with persistent atrial fibrillation (PsAF), mean age 60.7 ± 9.1 years, 76.6% male, median PsAF duration 6.0 months.

I

Intervention

CartoFinder algorithm guided ablation (CFGA) targeting repetitive activation patterns (RAPs) and focal impulses (FIs) for up to five iterations, followed by pulmonary vein isolation (PVI).

O

Outcome

Acute and long-term effectiveness (12-month arrhythmia-free and symptomatic AF-free rates) and peri-procedural safety (primary adverse events)

CartoFinder algorithm-guided ablation targeting repetitive activation patterns and focal impulses is feasible in persistent AF, with acute AF termination predicting better 12-month arrhythmia-free survival.

Implication

Acute AF termination during CartoFinder ablation was associated with higher arrhythmia-free survival; hypothesis-generating and requires randomized confirmation before practice change.

Abstract

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.