Bckground:
Pulmonary Vein Antrum Isolation (PVAI) is a widely accepted treatment option in Atrial Fibrillation (AF). However, despite procedural advancements, post-PVAI AF recurrences remain a common challenge. We thought to investigate whether the addition of routine 3D electroanatomical mapping and routine use of irrigated ablation catheters (IC) vs 8 mm tip catheters made an impact on the outcomes of PVAI guided by intracardiac echocardiography (ICE) and a decapolar circular mapping catheter (CMC) alone.
Methods:
Patient and procedural data were collected for 884 AF consecutive patients undergoing PVI at a single Canadian center during 2004 - 2014 (469 patients in 2004-2009, Group 1vs. 415 patients in 2010-2014, Group 2). Group 1 patients received PVAI guided by ICE and CMC. All Group 2 patients had PVAI guided by ICE, CMC and 3D mapping with the use of irrigated tip ablation catheters. Mean ages for Groups 1 and 2 were = 58.6 ± 10.0 and 61.0 ± 10.7 years respectively (p= 0.001). Mean follow up time was 17.1 ± 18.8 months for Group 1 and 14.1± 9.7 months for Group 2 (p=0.003). ECG and ambulatory monitoring was performed at 1, 3, 6, and 12 months. Recurrences ≤ 3 months post-PVI were considered Early (ER), while recurrences after 3 months post-PVI were considered Late (LR). Using survival analysis, rates of LR stratified by AF type [Paroxysmal AF (PAF) vs. Non-PAF (NPAF)] were compared between the two cohorts
Results:
ER rate was lower in Group 2 vs. Group 1 (36.8% vs. 44.7%, P=0.05) in patients with PAF and for those with NPAF (54.8% vs. 66.9%, P=0.03). LR rates did not differ between the Groups among PAF patients (62.5% in Group 1 vs. 57.3% in Group 2, P=0.16), but improved significantly for the NPAF patients (55.6% in Group 1 vs. 37.9% in Group 2 , P=0.002).
Conclusion:
Late recurrence of AF post-PVI has dramatically improved since 2010 for patients with persistent AF following routine addition of 3D mapping to ICE and CMC, while substituting an irrigated for an 8mm ablation catheter.
Comparison of circumferential pulmonary vein anatomy mapping guided by 3D mapping versus a mesh mapping catheter
