Abstract 17607: Substrate Based Atrial Fibrillation Ablation Guided by Voltage Gradient Mapping: Initial Results and Near-Term Clinical Outcome
Background: Ablation of atrial fibrillation (AF) is anatomic based with isolation of pulmonary veins (PVs), generally in combination with linear ablation. Because AF is chaotic, activation mapping cannot reveal underlying mechanisms or reasons for success or failure. We report substrate based ablation guided by voltage gradient mapping (VGM) provides promising initial and near-term success.
Methods and Results: 55 consecutive patients undergoing AF ablation, 29 paroxysmal (PAF) and 26 chronic (CAF), had contact voltage mapping within the left and right atrium, PVs, SVC, and IVC. Adjustment of voltage levels displayed low voltage connections between higher voltage regions. Ablation of low voltage bridges (LVB) was performed until repeat maps had no demonstrable LVB. Ablation endpoints were termination of AF and failure to induce AF or tachycardia. Clinical success was defined by the absence of recurrent AF (primary endpoint), and freedom from sustained arrhythmias (secondary endpoint) documented by 30 day monitoring 4 months following ablation. LVB ablation resulted in AF termination in 43/46 patients (93%) and AF was not inducible in 52/55 (95%). Single procedure success for prevention of recurrent AF was 51/55 (93%) and freedom from atrial arrhythmia was 39/55 (71%) (PAF: 86%; CAF: 56%). Following a second procedure the arrhythmia free success was 49/55 (89%); PAF: 97%; CAF: 81%.
Conclusions: We conclude that VGM of atrial substrate is an effective tool to guide ablation therapy. This method provides a high single procedure success in both PAF and CAF achieving the primary endpoint in 95% and secondary endpoint of 71%.
- © 2011 by American Heart Association, Inc.