Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current. (9th March 2020)

• Record Type: Journal Article
• Authors: Gunawardene, Melanie A.; Eickholt, Christian; Akbulak, Ruken Ö.; Jularic, Mario; Klatt, Niklas; Hartmann, Jens; Schlüter, Michael; Meyer, Christian; Willems, Stephan; Schaeffer, Benjamin
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 31:Number 5(2020)
• Page Start: 1051
• Page End: 1061
• Publication Date: 2020-03-09
• Subjects: atrial fibrillation -- contact‐force radiofrequency catheter ablation -- cryoballoon ablation -- pulmonary vein isolation -- ultra–high‐density mapping; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.14413
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Introduction: The aim of this study was to investigate electrophysiological findings in patients with arrhythmia recurrence undergoing a repeat ablation procedure using ultra–high‐density (UHDx) mapping following an index procedure using either contact–force (CF)‐guided radiofrequency current (RFC) pulmonary vein isolation (PVI) or second‐generation cryoballoon (CB) PVI for treatment of atrial fibrillation (AF). Methods and Results: Fifty consecutive patients with recurrence of AF and/or atrial tachycardia (AT) following index CF‐RFC PVI (n = 21) or CB PVI (n = 29) were included. A 64‐pole mini‐basket mapping catheter in combination with an UHDx‐mapping system‐guided ablation was used. RFC was applied using a catheter tip with three incorporated mini‐electrodes. PV reconnection rates were higher after CF‐RFC PVI (CF‐RFC: 2.5 ± 1.3 PVs vs CB: 1.4 ± 0.9 PVs; P = .0025) and left PVs were more frequently reconnected (CF‐RFC: 64% PVs vs CB: 35% PVs; P = .0077). Fractionated signals along the antral index ablation line (FS) were found in 30% of CB‐PVI patients (CF‐RFC: 9.5% vs CB:30%; P = .098) targeted for ablation. In five cases, FS were a critical part of maintaining consecutive AT. The main AT mechanism found during reablation (n = 45 ATs) was macroreentry (80% [36/45], CF‐RFC: 78.9% vs CB: 80.8%; P = 1.0) with a variety of circuits throughout both atria. Conclusion: UHDx mapping is sensitive in detecting conduction gaps along the index ablation line. Left PVs are more frequently reconnected after initial CF‐RFC PVI. FS are a common finding after CB PVI and can maintain certain forms of ATs. ATs after index PVI are mostly macroreentries with a broad spectrum of entities.