Targeting Nonpulmonary Vein Sources in Persistent Atrial Fibrillation Identified by Noncontact Charge Density Mapping
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Key result
Noncontact charge density mapping-guided ablation of nonpulmonary vein targets in persistent atrial fibrillation achieved 72.5% single-procedure freedom from AF at 12 months.
Why the study?
Identification and elimination of nonpulmonary vein targets may improve clinical outcomes in patients with persistent atrial fibrillation.
Does catheter ablation guided by noncontact charge density mapping improve freedom from atrial fibrillation in patients with persistent atrial fibrillation?
Population
129 persistent AF patients aged 18 to 80 scheduled for de novo catheter ablation
Comparison
Ultrasound and noncontact charge density mapping to guide ablation before pulmonary vein isolation
Design
Prospective nonrandomized multicenter trial
Follow-up
12 months
Authors
Discussion
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Implication
May support noncontact mapping for non-PV ablation in persistent AF; leaves open efficacy versus standard approaches pending RCTs.
Study Design
Type
Cohort (n=129)
Multicenter
Yes
Structured PICO
Does catheter ablation guided by noncontact charge density mapping improve freedom from atrial fibrillation in patients with persistent atrial fibrillation?
P
Population
129 patients with persistent atrial fibrillation (>7 days, <1 year) aged 18 to 80 years, scheduled for de novo catheter ablation, mean age 62.4, 75.2% male, multinational (13 centers across Europe and Canada). Key exclusions: prior history of ablation or surgical intervention for any atrial arrhythmia, AF episode lasting longer than 12 months, LVEF < 40% or LA size > 50 mm, and any history of documented cerebrovascular event or systemic embolism.
I
Intervention
Catheter ablation guided by noncontact charge density mapping (AcQMap system) to target nonpulmonary vein sources in addition to wide antral pulmonary vein isolation.
O
Outcome
Freedom from atrial fibrillation >30 seconds at 12 months for a single procedurehard clinical
Noncontact charge density mapping safely guided ablation of nonpulmonary vein targets in persistent atrial fibrillation, achieving 72.5% single-procedure freedom from AF at 12 months.
Limitations
- Nonrandomized design limiting the generalizability of the results
- Verification of rhythm status was 24 hours in duration at each scheduled follow-up compared with an implantable loop recorder, which may reflect an overinflation of outcome rates
- No assessment of AF burden was made at baseline
- The need for retreatment was attributed to AF, which may have been AFL or AT due to lack of documentation
- Data represent outcomes obtained with a first-generation system design
Cite This Study
Willems et al. (2019) conducted a cohort in Persistent Atrial Fibrillation (n=129). Noncontact charge density mapping-guided catheter ablation (AcQMap system) + pulmonary vein isolation was evaluated on Freedom from AF >30 seconds at 12 months for a single procedure (with or without antiarrhythmic drugs) (95% CI 63.9%-80.3%). Noncontact charge density mapping-guided ablation of nonpulmonary vein targets in persistent atrial fibrillation achieved 72.5% single-procedure freedom from AF at 12 months.
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