Individualized ablation strategy to treat persistent atrial fibrillation: Core-to-boundary approach guided by charge-density mapping
| Autor: | Michael Pope, Emily Cantor, Timothy R. Betts, Tom Wong, Shouvik Haldar, Junaid A.B. Zaman, Vias Markides, Zhong Chen, Haseeb Valli, Michael T Debney, Alessio Marinelli, David G. Jones, Rui Shi, Wajid Hussain, Vennela Boyalla, Nabeela Karim, Anitha Sathishkumar |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Catheter ablation 030204 cardiovascular system & hematology Pulmonary vein 03 medical and health sciences 0302 clinical medicine Posterior wall Heart Conduction System Heart Rate Recurrence Physiology (medical) Internal medicine Atrial Fibrillation Humans Medicine Prospective Studies 030212 general & internal medicine Propensity Score Atrial tachycardia Core (anatomy) business.industry Body Surface Potential Mapping Atrial fibrillation Middle Aged Ablation medicine.disease Treatment Outcome Surgery Computer-Assisted Pulmonary Veins Persistent atrial fibrillation Catheter Ablation Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Heart Rhythm. 18:862-870 |
| ISSN: | 1547-5271 |
| Popis: | Noncontact charge-density mapping allows rapid real-time global mapping of atrial fibrillation (AF), offering the opportunity for a personalized ablation strategy.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.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.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).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. |
| Databáze: | OpenAIRE |
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