Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Catheter ablation for persistent atrial fibrillation (AF) has historically yielded limited success.
• Identifying and targeting AF drivers remains a challenge in ablation procedures.

Purpose of the Study:

• To evaluate the efficacy of using periodicity and similarity (PRISM) mapping to guide catheter ablation for persistent AF.
• To determine if PRISM-guided ablation, when added to pulmonary vein isolation (PVI), improves outcomes compared to conventional ablation.

Main Methods:

• A prospective randomized clinical trial involving 170 patients with persistent AF across three Asian centers.
• Patients were randomized 1:1 to either a PRISM-guided ablation approach or a conventional ablation approach.
• The primary outcome was freedom from AF or other atrial arrhythmia lasting longer than 30 seconds at 6 and 12 months post-procedure.

Main Results:

• Significantly more patients in the PRISM-guided group achieved freedom from AF at 12 months (70.6%) compared to the conventional group (47.1%).
• Multivariate analysis confirmed that the PRISM-guided approach was independently associated with freedom from atrial arrhythmia recurrence (HR, 0.53; 95% CI, 0.33-0.85).

Conclusions:

• PRISM mapping, utilizing waveform similarity and recurrence patterns from high-density mapping, offers a more effective strategy for persistent AF ablation.
• This substrate ablation strategy demonstrates a reduced frequency of recurrent AF and an increased likelihood of maintaining sinus rhythm compared to conventional methods.