Key result
Circular mapping catheter-free CLOSE-guided PVI achieves ~99% acute isolation in observational cohort.
Why the study?
Catheter ablation for AF traditionally requires a circular mapping catheter, motivating evaluation of the feasibility and effectiveness of a CMC-free approach using the CLOSE protocol.
Is a CMC-free CLOSE-guided PVI approach feasible, safe, and effective in patients with atrial fibrillation?
Observational (n=67)
Open-label
No
Is a CMC-free CLOSE-guided PVI approach feasible, safe, and effective in patients with atrial fibrillation?
A CMC-free CLOSE-guided PVI approach is feasible, safe, and cost-saving, yielding excellent 1-year clinical outcomes for AF ablation.
Supports feasibility of CMC-free CLOSE-guided PVI in this cohort; leaves open confirmation versus standard mapping in randomized trials.
BACKGROUND: Catheter ablation for atrial fibrillation (AF) traditionally requires the use of circular mapping catheter (CMC) for pulmonary vein isolation (PVI). This study aimed to assess the feasibility and effectiveness of a CMC-free approach for AF ablation performed by a contiguous optimized (CLOSE) ablation protocol. METHODS: A CLOSE-guided and CMC-free PVI protocol with a single transseptal puncture was attempted in 67 patients with AF. Left atrial (LA) CARTO voltage mapping was performed with the ablation catheter pre- and postablation to demonstrate entry block into the pulmonary veins, and pacing maneuvers were used to confirm exit block. RESULTS: The CMC-free approach was successful in achieving PVI in 66 (98.5%) cases, with procedure time of 148 ± 32 minutes, ablation time of 27.5 ± 5.7 minutes, and fluoroscopy time of 7.8 ± 1.0 minutes. First-pass PVI was seen in 58(86.5%) patients, and pacing maneuvers successfully identified the residual gap in eight of the other nine cases. No complication was observed. At 12 months follow-up, 60 (89.6%) patients remained free from AF. The CMC-free approach resulted in a cost saving of £47,190. CONCLUSION: A CMC-free CLOSE-guided PVI approach is feasible, safe, and cost-saving, and is associated with excellent clinical outcomes at 1 year.
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Chin et al. (2020) conducted an observational in Atrial fibrillation (n=67). Circular mapping catheter (CMC)-free CLOSE-guided pulmonary vein isolation was evaluated on Successful pulmonary vein isolation (feasibility). A circular mapping catheter-free CLOSE-guided pulmonary vein isolation approach successfully achieved isolation in 98.5% of cases, with 89.6% of patients free from atrial arrhythmias at 1 year.
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