High-density versus low-density mapping in ablation of atypical atrial flutter

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Atypical atrial flutter (AAFL) ablation can be challenging.
• High-density (HD) mapping may improve procedural success and reduce AAFL recurrence.

Purpose of the Study:

• To evaluate the effectiveness of HD mapping in AAFL ablation.
• To compare outcomes using HD Grid catheter with EnSite Precision versus standard catheters and lower-density systems.

Main Methods:

• Comparison of three groups: HD Grid + EnSite Precision, standard catheter + EnSite Precision, and standard catheter + EnSite Velocity.
• Construction of voltage and propagation maps.
• Assessment of procedural success, safety, and AAFL recurrence at 1-year follow-up.

Main Results:

• Acute ablation success was higher with HD Grid + EnSite Precision (78%) compared to other groups (68%, 51%).
• Fewer flutters were unmappable using HD Grid + EnSite Precision (8%) versus other groups (27%, 36%).
• AAFL recurrence at 1 year was lower with HD mapping (26%) compared to standard methods (36%, 62%).

Conclusions:

• HD mapping with the HD Grid catheter and EnSite Precision system enhances acute procedural success and reduces unmappable flutters in AAFL ablation.
• This approach may lead to improved freedom from recurrent AAFL at one year.
• HD mapping is a safe technique for AAFL ablation.