Abstract 621 Dipole Density Guided Ablation for Persistent Atrial Fibrillation: First Long Time Outcome Data and Procedural Insights

Clin Res Cardiol (2021) DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Dipole Density Guided Ablation for Persistent Atrial Fibrillation: First Long Time Outcome Data and Procedural Insights
A. Sultan¹, J. Lüker¹, J.-H. van den Bruck¹, J. Wörmann¹, K. Filipovic¹, Z. Arica¹, C. Scheurlen¹, S. Dittrich¹, J. Terporten¹, S. C. R. Erlhöfer¹, D. Steven¹
¹Abteilung für Elektrophysiologie, Herzzentrum der Universität zu Köln, Köln;
Background The AcQMap^® is a non-contact high-resolution system using a single array-shaped AcQMap^® catheter (AC) providing 48 ultrasound probes and electrodes for 3D anatomy reconstruction and continuous dipole density (DD) mapping, displaying AF wave fronts. Latter are discerned in 3 patterns: a. Focal activity, b. Rotational mechanism and c. Irregular mechanism. Safety and feasibility of the system has been reported earlier. Thus, the system has now been used more frequently to guide catheter ablation (CA) of persistent AF (persAF). So far, only few data exist on intraprocedural data during DD guided persAF ablation and no long-term outcome data were available until now. Objective We sought to evaluate procedural data regarding number of acquired maps, final rhythm and revealed dominant AF mechanisms before termination. Also, evaluation of long-time outcome data was performed regarding arrhythmia recurrence and repeat procedures. Methods Maps and recorded AF-wavefronts of 41 patients who underwent DD guided ablation for persAF were analyzed regarding: 1. Total number of acquired maps, 2. Evaluation of dominant AF wave patterns (a. Focal activity, b. Rotational mechanism, c. Irregular mechanism) and 3. rhythm before termination of persAF or atrial tachycardia (AT) including atrial flutter, into SR by ablation or external cardioversion (CV). Also, long-term outcome data were obtained. Results In 41 pts with persAF an DD guided CA for AF was performed. An average of 5±2 consecutive DD maps per patient were obtained. The last recorded rhythm before termination into SR was AF for 28 (68%) and AT for 13 (32%) pts. For 24 (59%) pts SR was achieved by CA. Due to futility of further ablation for 17 (41%) pts a CV was delivered to obtain SR. The dominant AF wave front pattern in these maps was an irregular mechanism (n=32), followed by rotational (n=15) and focal mechanism (n=12). A sub-analysis for spatial distribution revealed the antero-septal LA, adjacent to LAA and at the postero-inferior LA as predominant wave front sites. During a follow-up (FU) of 631±329 days 34 (73%) pts were without any relapse of AF (22(54%) pts were in SR and 11(27%) pts in AT). In 7(17%) pts recurrence of AF (2 PAF; 5 persAF) was detected during FU. All pts with relapse of AF or AT underwent a CV. A repeat ablation was performed in 13(32%) patients. One patient died of non-cardiac cause during FU. Conclusion In a routine setting for CA of persAF, the AcQMap® catheter and system delivers reproducible DD persAF maps identifying dominant AF wave front pattern and therefore potentially pivotal sites for persAF termination. First long-term data after DD guided ablation revealed a remarkably low recurrence rate of persAF. However, consecutive AT may occur but are often more promising to undergo ablation.
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