Outcomes of catheter ablation of atrial tachyarrhythmia guided exclusively by activation mapping
Xiaodong Zhang1, Weijia Li2, Aung Lin1
1Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Insights
High-definition mapping (HDM) alone for complex atrial tachyarrhythmias (CATs) ablation shows similar success to entrainment mapping. HDM-only approach avoids unintended arrhythmia termination during procedures.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Complex atrial tachyarrhythmias (CATs) frequently occur post-cardiac procedures.
- Traditional entrainment mapping is complex for characterizing CATs.
- High-definition mapping (HDM) offers detailed visualization of arrhythmia circuits.
Purpose of the Study:
- To evaluate catheter ablation outcomes for CATs using HDM exclusively.
- To compare HDM-only strategy with combined entrainment and HDM approaches.
Main Methods:
- Retrospective analysis of 67 patients undergoing CAT ablation (2017-2021).
- Group I: HDM-only mapping; Group II: HDM with entrainment mapping.
- Exclusion of right atrial tachyarrhythmias.
Main Results:
- No significant difference in 1-year freedom from atrial arrhythmias between groups (80% vs 77.8%).
- Four CATs terminated by entrainment in Group II versus none in Group I (p=0.011).
Conclusions:
- HDM-alone catheter ablation is as effective as combined methods for CATs.
- Entrainment mapping may increase the risk of unintended arrhythmia interruption.
- Randomized trials are needed for further validation.
Introduction:
Complex atrial tachyarrhythmias (CATs) are commonly observed in patients with prior catheter ablation or cardiac surgery. These arrhythmias are challenging to map and ablate. Historically, entrainment mapping was utilized to characterize CAT. With the advent of high-definition mapping (HDM), full visualization of the CAT circuit is possible which may obviate the need for entrainment mapping.
Methods:
We sought to investigate the outcomes of catheter ablation of CAT guided only by HDM. Consecutive patients who underwent CAT ablation from 2017 to 2021 were included in our study (excluding right atrial tachyarrhythmias). Patients were sorted by the type of mapping performed. Group I consisted of patients where HDM alone was utilized with no attempt of entrainment. Group II consisted of patients where both entrainment and HDM were utilized.
Results:
A total of 67 patients were included in our study, with 40 patients in HDM group (I) and 27 patients in entrainment group (II). No statistically significant difference regarding 1-year freedom from atrial arrhythmias was found between the two groups (80% vs 77.8%, p = 0.819). Four CATs were terminated by entrainment during procedure versus none in the HDM-only group (p = 0.011).
Conclusions:
CAT ablation with HDM alone yielded similar 1-year freedom from atrial arrhythmias compared to ablation with HDM and entrainment. Entrainment combined with HDM was associated with higher undesired CAT interruption rate. Further validation is needed with randomized control trials.
