Abstract 14697: A Method of Entrance and Exit Gap Mapping for Effectively Detecting and Ablating the Residual Conduction Gap in the Linear Ablation Line for Circumferential Pulmonary Vein Antrum Isolation
Background: Circumferential pulmonary vein (PV) antrum isolation (CPVAI) is the cornerstone in atrial fibrillation (AF) ablation. Linear ablation around the ipsilateral PVs for CPVAI often results in incomplete PV isolation, and touch-up ablation for residual conduction gap (CG) is required, which is difficult and time-consuming in some cases. We sought to establish a simple and reliable method for detecting CG with CARTO 3 and multipolar PentaRay catheter.
Methods and Results: The consecutive 65 AF patients (mean age, 65±7; paroxysmal AF, 69%) were studied. CPVAI was done with linear, successive ablation using a Thermocool SmartTouch catheter at target contact force between 10 and 20 g. To assess the completeness of CPVAI, the activation map of the left atrium (LA) and PVs was created after ablation by roving sequentially a PentaRay catheter in the LA and PVs while recording 10 bipolar electrograms simultaneously. Mapping was done during pacing from the coronary sinus or sinus rhythm (entrance CG map) and if entrance CG was present, during pacing from the non-isolated PV (exit CG map). Of the 130 ipsilateral PVs of the 65 patients, 97 (75%) were completely isolated by the first linear ablation, whereas the remaining 33 (25%) had residual CG and were further analyzed. Mean times for creating entrance and exit CG maps were 2.4±1.8 and 3.0±1.3 minutes, respectively. Entrance CG site was easily identified by setting the color bar of local activation time as red for the left atrium outside the ablation line and then shifting the red color zone to the later activation at which the inside of the ablation line started being activated. Exit CG was similarly identified by setting the color bar as red for the inside of the ablation line. A total of 47 CG sites in the 33 ipsilateral PVs (mean, 1.4 per PVs) were detected by entrance and exit maps (28 in the left and 19 in the right). Concordance between entrance and exit CGs was found in 28 ipsilateral PVs, whereas CG site was different in the other 5. All CGs were successfully ablated by a median of one application for each CG, and complete CPVAI was finally achieved in all patients.
Conclusion: The present entrance and exit CG mapping with a PentaRay catheter after linear ablation for CPVAI is useful to detect residual CG and achieve complete CPVAI.
Author Disclosures: Y. Tanaka: None. K. Okumura: Speakers Bureau; Significant; Johnson&Johnson, Medtronic. M. Kajiwara: None. H. Okamatsu: None. T. Tsurugi: None. J. Koyama: None. T. Sakamoto: None. K. Nakao: None.
- © 2016 by American Heart Association, Inc.