Abstract 17613: Defining Clinical Indexes of Good Basket Placement that Predict Successful Outcome From Atrial Fibrillation Rotor Ablation
Introduction: Ablation for atrial fibrillation (AF) needs improvement, yet it is unclear what to ablate beyond the pulmonary veins since trials question fractionated electrograms or lines. Ablation of rotors and focal sources guided by contact baskets is promising, but with recent disappointing results in one study in which basket contact was poor. We related basket position to fluoroscopic landmarks to determine indexes of optimal placement that predict successful AF rotor ablation.
Methods: We studied 60 AF patients (62±10 years, 65% persistent) in whom AF was mapped by 64-pole baskets of 48-60 mm diameter, sized by echocardiography or computed tomography. Cineangiograms were used to determine in blinded fashion if left atrial (LA) baskets lay near the floor (coronary sinus, Fig A) or not (Fig B), or if RA or LA baskets were deformed by the atria in 1 image (static) or during multiple cardiac cycles (dynamic; arrows in Fig C). Ablation comprised rotor targeting then PVI, with follow-up per guidelines.
Results: Using bi-atrial baskets, 205 sources (LA 138; RA 67) were ablated (3.6±1.4/patient). In static images, LA baskets reached the floor in 44 (73%) and were deformed in 54 (90%). Dynamic basket deformation was seen in LA in 39 (65%) and RA in 51 (85%). Presence of LA deformation directly correlated with LVEF, inversely correlated with NYHA functional class (each p=0.05), and was related to good LA coverage. Single procedure AF-freedom at 1 year was higher in patients with dynamic LA deformation than in those without (80% vs. 57%; p=0.07), but unrelated to other indices.
Conclusions: Atrial basket positioning is a new but important skill for implementing AF rotor ablation. This study is the first to systematically examine optimal indexes of good basket contact, and found that dynamic deformation of basket splines during systole predicted successful AF rotor ablation more effectively than other indexes.
Author Disclosures: A.A. Schricker: None. T. Baykaner: None. J. Zaman: None. G. Lalani: None. K. Hopper: None. A. Moyeda: None. D.E. Krummen: Research Grant; Significant; NIH, AHA. Consultant/Advisory Board; Modest; Topera, In Silico Med. Other; Significant; Medtronic, St Jude Medical, Boston Scientific, Biotronik, Biosense Webster. S.M. Narayan: Research Grant; Significant; NIH. Honoraria; Modest; Medtronic, St Jude Medical, Biotronik, Boston Scientific. Consultant/Advisory Board; Significant; Abbott.
- © 2015 by American Heart Association, Inc.