Feasibility of Mapping and Ablation of Scar-Related Atrial Flutter Using a Novel High-Density 3-Dimensional Electroanatomic Mapping System

BACKGROUND: Scar-related atrial flutter (AFL) comprises complex reentrant atrial arrhythmias arising from areas of slow conduction typically in the setting of prior ablation, cardiac surgery, or atrial cardiomyopathy. Three-dimensional electroanatomic mapping is essential to define these complex circuits. OBJECTIVE: This study evaluated the feasibility of mapping and ablation of AFL using the Affera mapping and ablation system. METHODS: This single-center retrospective study included consecutive patients who underwent high-density mapping and catheter ablation of scar-related AFL using Sphere-9 catheter and Prism-1 software. The primary efficacy outcome was defined as termination of the AFL at the initial ablation site or within the surrounding area. Secondary efficacy outcomes were termination of AFL with ablation at any site and AFL recurrence on/off antiarrhythmic drugs during follow-up. RESULTS: A total of 65 patients were included. Most patients had undergone ≥1 previous atrial fibrillation ablation procedure (87.7%). Median mapping time was 8 (6-10) minutes, with a median number of points acquired on activation maps of 835 (510-1175) for the right atrium and 1859 (1418-2531) for the left atrium. Termination of the clinical AFL at the initial ablation size or surrounding area was achieved in 79.4% of patients. Termination of AFL with ablation at any site was achieved in all patients. During a median follow-up of 69 (49-116) days, AFL recurrence occurred in 15% of patients. CONCLUSIONS: The study results demonstrate the feasibility of Affera 3D-EAM System to successfully map and ablate scar-related AFLs.