Abstract 19629: Experience With a Novel Hybrid Cryo/rf Focused Technique in Long-Standing Persistent Atrial Fibrillation - Low Voltage Bridge Mapping
Introduction: Despite advances in catheter technologies and energy sources for atrial fibrillation (AF) ablation, patient outcomes when treating long-standing persistent AF with pulmonary vein isolation (PVI) combined with empiric roof and isthmus lines is inferior to those seen in paroxysmal AF. Recent advances in mapping systems allow very detailed substrate analysis to be performed rapidly. We previously described a method of substrate ablation (SA) by targeting low voltage bridges (LVB) based upon voltage gradient mapping (VGM). Studies have suggested that targeting “low voltage bridges” (LVB) can be successful in ablating atrial fibrillation, atrial flutter, and slow pathways. We sought to apply this technique in these difficult patients with long-standing persistent AF.
Methods: 31 pts (24M/7F) mean age 61 (42-78 yrs) with mean AF duration 2.4 (.75-4.0 yrs) underwent AF ablation between December, 2014 and May, 2016. The procedure consisted of initial PVI using a 28 mm cryoballoon (Arctic Front, Medtronic, Mpls., MN) followed by detailed mapping of the left atrium using the Navix mapping system and an HD catheter (St. Jude Medical, Mpls, MN). 2 pts. required additional right atrial mapping. Low-voltage bridges were determined and then ablated using a 4 mm tip RF catheter. Sequential mapping was performed after each “layer” of LVBs was eliminated until no LVBs could be found in the chamber.
Results: 29 of 31 procedures were successful with all of these patients remaining in sinus rhythm at most recent f/u on no (26 pts) or tapering (3 pts) antiarrhythmic drug therapy. Mean f/u duration 8.5 mos (1-18). Two patients left the hospital in AF. One failed a cardioversion after a 3-month amiodarone load and had subsequent AV nodal ablation and pacemaker placement.
Conclusions: These early positive outcomes suggest that a more targeted approach to ablation in long-standing persistent AF targeting LVBs may be superior to empiric roof and isthmus lines. We are early in our experience, however, and will need more patients and longer follow-up to confirm these results.
Author Disclosures: M.C. Giudici: None. S.J. Bailin: None.
- © 2016 by American Heart Association, Inc.