Optimizing ablation sites for pulmonary vein isolation reconnections: A novel approach using an emphasis map combined
Shuhei Okajima1, Yuhi Fujimoto1, Masato Hachisuka1
1Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
Background:
Although catheter ablation techniques for atrial fibrillation (AF) have advanced, some cases of reconnections after pulmonary vein (PV) isolation still exist. The diversity of the anatomic wall thickness and fiber orientation around the PVs might contribute to reconnections.
Objective:
The purpose of this study was to investigate the utility of the emphasis map's emphasize settings to determine optimal ablation sites.
Methods:
Patients undergoing AF ablation with the EnSite X system who had PV reconnections were included. The emphasis map (a combination of peak frequency and local activation timing [LAT] maps) was created to obtain the emphasize settings for indicating the optimal ablation site (Emphasis group). In another group, the ablation site was determined based on LAT mapping (LAT group).
Results:
A total of 64 patients (age 69 ± 9 years; 50 males), and 109 PVs were found to be reconnected and analyzed. Gaps were observed at 55 and 68 points of the PV isolation in the Emphasis and LAT groups, respectively. The number of ablation points needed to successfully eliminate the gaps, and the total energy were markedly smaller (1.6 ± 1.1 vs. 6.3 ± 3.7, P <.001; 3541 ± 2060 J vs 5606 ± 3728 J, P = .001) in the Emphasis group than in the LAT group, respectively. The average optimal emphasize setting was 338 ± 67 Hz in the Emphasis group.
Conclusion:
Adjusting the emphasize settings visualized the optimal ablation site, and the number of ablation points needed to reisolate the PV might be markedly reduced.
