One-year outcomes in patients with persistent atrial fibrillation using CARTOFINDER mapping with OCTARAY: a Shinshu-AB registry study

INTRODUCTION: Persistent atrial fibrillation (PerAF) has no established method of catheter ablation. Although catheter ablation using CARTOFINDER has shown some therapeutic effects, the associated prolonged procedure time remains a challenge. The identification of focal or rotational activation sites by CARTOFINDER using OCTARAY™ Mapping Catheter (OCTARAY) suggests that it can more efficiently detect the activation sites owing to its greater coverage of the left atrium (LA). This study aimed to compare the outcomes of catheter ablation guided by CARTOFINDER versus BOX isolation (BOXI) in patients with PerAF. METHODS: Using the Shinshu-AB registry, the study included 117 patients with PerAF who underwent catheter ablation between May 2021 and May 2024. The patients were matched at 1:1 ratio (n = 39 each): Group 1 underwent CARTOFINDER-guided catheter ablation, and Group 2 underwent BOXI-guided catheter ablation. CARTOFINDER detection was limited to four sites on the LA posterior wall, the LA appendage ostium, and the LA septum, for a total of six sites. RESULTS: Procedure time was significantly shorter in Group 1 (140.2 ± 37.7 vs. 174.4 ± 74.1 min, p = 0.016). The 1-year AF recurrence rate was significantly lower in Group 1 (17.9% vs. 38.5%, p = 0.031). Based on Cox proportional hazards regression analysis, AF duration and CARTOFINDER-guided catheter ablation were both independent predictors of recurrent AF after catheter ablation for PerAF. CONCLUSION: Compared to BOXI, CARTOFINDER-guided catheter ablation may lead to better outcomes in patients with PerAF.