Sequential ultrahigh-density contact mapping of persistent atrial fibrillation: An efficient technique for driver...

Area of Science:

• Electrophysiology
• Cardiology
• Medical Devices

Background:

• Atrial fibrillation (AF) is maintained by drivers.
• The utility of ultrahigh-density (UHD) contact mapping for driver detection is unknown.

Purpose of the Study:

• To determine if UHD contact mapping can detect atrial fibrillation drivers.
• To evaluate a sequential strategy of pulmonary vein isolation and driver ablation.

Main Methods:

• Ninety patients with persistent AF underwent sequential LA mapping using Rhythmia™.
• Circumferential pulmonary vein isolation (CPVI) was performed, followed by remapping and ablation of identified drivers.
• Fifty-one patients without prior ablation were analyzed for acute and long-term outcomes.

Main Results:

• UHD mapping visualized potential drivers (rotational and focal) post-CPVI in all patients.
• Driver ablation increased AF organization, with a significant increase in organized LA surface (14% to 28%, p=.0007).
• AF terminated without cardioversion in 67%, with a 17.6% recurrence rate at 15 months.

Conclusions:

• Sequential UHD contact mapping effectively visualizes AF drivers.
• A strategy combining CPVI and driver ablation leads to improved AF organization and favorable clinical outcomes.