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High density mapping guided partial antral ablation for a pulmonary vein isolation.
Jongmin Hwang1, Seongwook Han2, Chun Hwang3
1Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-daero Dalseo-gu, Daegu, 42601, Republic of Korea.
Scientific Reports
|August 17, 2021
Summary
High-density mapping identified muscular discontinuities in pulmonary vein (PV) isolation. Partial antral ablation targeting directly activated segments proved feasible and effective for drug-refractory atrial fibrillation (AF) patients.
Area of Science:
- Electrophysiology
- Cardiac Ablation
- Atrial Fibrillation Research
Background:
- Muscular discontinuities at the pulmonary vein (PV)-left atrial (LA) junction are recognized.
- High-density (HD) mapping may aid in identifying these muscular discontinuities.
Purpose of the Study:
- To evaluate the efficacy of partial antral ablation for PV isolation using HD mapping.
- To assess if targeting directly activated segments can achieve PV isolation.
Main Methods:
- Sixty drug-refractory atrial fibrillation (AF) patients undergoing catheter ablation were enrolled.
- HD mapping was used to classify PV and LA junction activation patterns.
- Partial antral ablation was performed on directly activated PV segments when passive activation was present.
Main Results:
- Passively-activated segments were found in 58.3% of PVs, with inferior PVs and posteroinferior segments showing higher proportions.
- A successful partial antral ablation rate of 85% was achieved.
- Atrial tachyarrhythmia recurrence was observed in 16.7% of patients at 1-year.
Conclusions:
- HD mapping effectively evaluates detailed PV activation patterns, suggesting passively-activated segments indicate muscular discontinuity.
- Partial antral ablation targeting only directly-activated segments is a feasible and effective strategy for PV isolation.
