Elsevier

Heart Rhythm

Volume 18, Issue 6, June 2021, Pages 862-870
Heart Rhythm

Clinical
Atrial Fibrillation
Individualized ablation strategy to treat persistent atrial fibrillation: Core-to-boundary approach guided by charge-density mapping

https://doi.org/10.1016/j.hrthm.2021.02.014Get rights and content
Under a Creative Commons license
open access

Background

Noncontact charge-density mapping allows rapid real-time global mapping of atrial fibrillation (AF), offering the opportunity for a personalized ablation strategy.

Objective

The purpose of this study was to compare the 2-year outcome of an individualized strategy consisting of pulmonary vein isolation (PVI) plus core-to-boundary ablation (targeting the conduction pattern core with an extension to the nearest nonconducting boundary) guided by charge-density mapping, with an empirical PVI plus posterior wall electrical isolation (PWI) strategy.

Methods

Forty patients (age 62 ± 12 years; 29 male) with persistent AF (10 ± 5 months) prospectively underwent charge-density mapping–guided PVI, followed by core-to-boundary stepwise ablation until termination of AF or depletion of identified cores. Freedom from AF/atrial tachycardia (AT) at 24 months was compared with a propensity score–matched control group of 80 patients with empirical PVI + PWI guided by conventional contact mapping.

Results

Acute AF termination occurred in 8 of 40 patients after charge-density mapping–guided PVI alone and in 21 of the remaining 32 patients after core-to-boundary ablation in the study cohort, compared with 8 of 80 (10%) in the control cohort (P <.001). On average, 2.2 ± 0.6 cores were ablated post-PVI before acute AF termination. At 24 months, freedom from AF/AT after a single procedure was 68% in the study group vs 46% in the control group (P = .043).

Conclusion

An individualized ablation strategy consisting of PVI plus core-to-boundary ablation guided by noncontact charge-density mapping is a feasible and effective strategy for treating persistent AF, with a favorable 24-month outcome.

Keywords

Catheter ablation
Conduction pattern core
Driver
Maintainer
Noncontact charge-density mapping
Persistent atrial fibrillation

Cited by (0)

Funding sources: Dr Wong acknowledged support from National Institute for Health Research (NIHR). Dr Betts is supported by the NIHR Oxford Biomedical Research Centre. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Disclosures: All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

1

Dr Timothy R. Betts and Dr Tom Wong are joint senior authors.