Abstract 11942: Stepwise Atrial Fibrillation Ablation Navigated by Non-Contact Mapping Performed After Pulmonary Vein Isolation: Comparison Between Paroxysmal and Persistent Atrial Fibrillation
Objectives: The purpose of this study was to define the mechanism of perpetuation of atrial fibrillation (AF) in paroxysmal and persistent AF after pulmonary vein isolation (PVI) and elucidate the usefulness of subsequent stepwise ablation navigated by non-contact mapping (NCM).
Methods: NCM (EnSite 3000) was performed after PVI in 54 paroxysmal and 31 persistent AF. Subsequently, we clarified the efficacy of additional catheter ablation navigated by NCM. Based on the findings of NCM, PVI, roof line lesion and complex fractionated atrial electrogram (CFAE) ablation were performed in a stepwise fashion during AF using an AF termination as a procedural endpoint.
Results: Random wave propagation after PVI was maintained by the activation around the isolated PV and mitral annulus, wave break and pivoting activation observed in the residual CFAE region. The CFAE area in persistent AF was significantly larger than that in paroxysmal AF after PVI (7.7±2.6 vs. 1.7±2.1 cm2, p≤0.0001) and thus the frequency of pivoting activation and wave break in persistent AF were higher than those in paroxysmal AF (11.5±4.9 vs. 2.1±2.0 times/sec; p≤0.0001, 2.6±2.0 vs. 0.1±0.1 times/sec; p≤0.002). AF termination was observed in 73 patients (88.2%). Termination of AF by PVI alone was more frequent in paroxysmal than persistent AF (41pateints; 83.7% vs. 3 patients; 12.5%, p≤0.0001). There was no difference in the prevalence of AF termination between paroxysmal and persistent AF following subsequent roof line lesion (6 patients; 12.2%, vs. 4 patients; 16.7%, p=NS). However, additional CFAE ablation eliminated random wave propagation and thus terminated AF more frequently in persistent AF than in paroxysmal AF (17 patients; 70.8% vs. 2 patients; 4.1%, p≤0.0001). Overall, there was no significant difference in the prevalence of AF termination between paroxysmal and persistent AF (49 patients; 90.7% vs. 24 patients; 77.4%, P=NS).
Conclusions: Disorganized activation after PVI was more prominent in persistent AF. CFAE ablation successfully terminated disorganized activation over the residual CFAE region especially in persistent AF. Stepwise catheter ablation, navigated by NCM mapping, effectively eliminates the random wave propagation perpetuated after PVI.
- © 2013 by American Heart Association, Inc.