Abstract 17822: Initial Procedural Results From the DDRAMATIC SVT Study: AF Mechanism Identification and Localization Using Dipole Density Mapping to Guide Ablation Strategy
Introduction: DDRAMATIC-SVT is a prospective non-randomized study to demonstrate safety and performance of a novel cardiac imaging/mapping system to reconstruct cardiac chambers using ultrasound (U/S) and globally map the atrial endocardial surface using dipole density (DD) to identify mechanisms and locations of atrial tachyarrhythmias.
Methods: Patients with Persistent/Long-standing Persistent AF scheduled for ablation were mapped using a basket catheter with 48 U/S crystals and 48 electrodes. DD inverse solution subtracts the effect of distant sources and displays a more localized map of activation. Conduction is displayed as a retrospective moving color-map. Red is present location of leading-edge, while trailing color-bands represent past locations in time. U/S anatomies were constructed and ~4 sec segments of AF mapped to identify mechanisms and locations. Pulmonary vein isolation/touch up was performed followed by mechanistically targeted ablation.
Results: A total of 6 sites enrolled 27 patients between Jan-May, 2016. (Available data: Mean age 60.7 yrs, 78% Male, AF duration 5.2 ± 4.7 yrs, 37% redo, 26% amiodarone, LA diameter 44.5 ± 6.1 mm). A total of 167 mechanisms were identified in pre-ablation maps. Mechanisms included 28.7% rotational activation (≥180 degrees), 31.1% focal (≥3 firings/map), 40.2% irregular reentry (entry/exit in confined zone). Average number of mechanisms/patient was 6.2. Number of mechanisms and average fibrillatory CL listed in Figure 1 by location. Targeted ablation resulted in CL prolongation and 33% AF conversion to SR or AT. No serious adverse outcomes occurred related to the System or Catheter.
Conclusions: Identifying and targeting actual AF mechanisms for ablation using DD is feasible. Pre-ablation maps identified rotational, irregular reentrant, and focal activation patterns. Targeted ablation of mechanisms altered conduction and/or resulted in AF conversion. Long-term outcome data is needed.
Author Disclosures: A. Grace: Research Grant; Significant; Acutus Medical. P. Heck: None. V. Reddy: Ownership Interest; Modest; VytronUS ACT AcutusMedical Iowa Approach. Ownership Interest; Significant; Manual Surgical Sciences. Consultant/Advisory Board; Significant; VytronUS ACT AcutusMedical IowaApproach. P. Neuzil: None. S. Willems: None. B. Hoffman: None. A. Verma: Consultant/Advisory Board; Modest; Bayer, Boehringer Ingelheim, Medtronic, Biosense Webster, St Jude Medical. R. Schilling: None. P. Lambiase: None. M. Hall: None.
- © 2016 by American Heart Association, Inc.