Abstract 20 Electrical Cardioversion of Atrial Fibrillation during Ablation Procedures with a 3-D-Mapping System: Feasibility and Minimal Energy Required

Clin Res Cardiol 107, Suppl 3, October 2018
Electrical Cardioversion of Atrial Fibrillation during Ablation Procedures with a 3-D-Mapping System: Feasibility and Minimal Energy Required
F. Heringhaus¹, L. Löhr¹, S. Lask¹, H. Neubauer², A. Mügge¹, A. Wutzler³
¹Med. Klinik II, Kardiologie, St. Josef Hospital, Ruhr-Universität Bochum, Bochum; ²Innere Medizin II - Kardiologie und internistische Intensivmedizin, St. Elisabeth-Hospital Herten gGmbH, Herten; ³Abt. Rhytmologie, St. Josef Hospital, Ruhr-Universität Bochum, Bochum;
Background: Catheter ablation is a standard treatment of atrial fibrillation (AF). Electrical cardioversion is commonly needed during AF ablation procedures to restore sinus rhythm and facilitate evaluation of procedural endpoints (entry block and exit block) or mapping of extra-pulmonary vein foci. It has been postulated that the anterior-posterior electrode position (Fig 1 a) is much more effective for cardioversion compared to other electrode positions. Catheter ablation for AF is mainly performed with the use of 3-D-mapping systems. However, due to the position of the 3-D-mapping surface electrodes, an anterior-posterior electrode position is not possible in AF ablation cases. At our centre, an alternative electrode position was established (Fig 1 b). Up to today, not data exist on the feasibility and efficacy of electrical cardioversion with alternative electrode positions during the use of a 3-D-mapping system. The aim of our study was to evaluate our alternative electrode position compared to the anterior-posterior position. Methods: Consecutive patients undergoing AF ablation that were in AF at the beginning of the procedure and underwent cardioversion with the alternative electrode position (Fig 1 b) were included in the study. Patients with concomitant arrhythmias other than AF (atrial flutter, atrial tachycardia) were excluded. Patients undergoing elective electrical cardioversion of AF with anterior-posterior electrode position (Fig 1 a) served as control group. In all patients, a standardized step-up protocol with increasing biphasic shock energy in 50 J steps was used (50-360 J). Cardioversion success and minimal energy required for cardioversion were primary endpoints. Results: From March 2016 to February 2018 a total of 215 patients were included, 141 in the control and 74 in the 3-D-mapping group. Minimal energy required for cardioversion was significantly lower in controls compared to the 3-D-mapping group (128.9?65.4 vs. 161.9?97 J, p=0.04). Mean number of shocks (2.8?1.7 vs. 3.3?2, p=0.1) and cardioversion success rate (96.5 vs. 98.6%, p=0.4) were not significantly different between the groups (Table 1). We found a significant positive correlation of energy and body mass index (r=0.3, p<0.001) and left atrial surface area (r=0.4, p=0.002, Table 2). Conclusion: The alternative electrode position established in our centre for procedures with a 3-D-mapping system resulted in a high cardioversion success rate. Minimal energy required for restoration of sinus rhythm was significantly higher with the use of a 3-D-mapping system. Yet, mean energy was still <200 J in this group. The alternative electrode position proposed by our centre seems feasible and effective for the use with a 3-D-mapping system.
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