Abstract 582 Ultra-High-Density Mapping during Catheter Ablation of Ventricular Tachycardia

Background:
Electro-anatomical ultra-high-density mapping depicts comprehensive information of the myocardial substrate and the arrhythmia mechanism. Whether this detailed insight translates into a better procedural outcome compared to a point-by-point mapping approach is not yet fully understood.

Methods:
We retrospectively compared the procedural parameters and long-term outcome of 122 consecutive patients whose ablation was either guided by ultra-high-density mapping using a 64-polar basket catheter (Intellamap OrionTM, Rhythmia HDxTM, Boston Scientific) or by conventional point-by-point 3D-mapping (Thermocool®, Carto®, Biosense Webster).

Results:
Patients with ultra-high-density mapping (age 64.9±12.7 years, 93.4% male, 60.7% ischemic cardiomyopathy) and patients with conventional point-by-point mapping (age 64.8±11.2 years, 91.8% male, 63.9% ischemic cardiomyopathy) had a similar acute procedural success rate (82.0% vs. 92.3%; P=0.145). The Kaplan-Meier estimate of recurrence-free survival at 12 months after ablation was 57.3% (95% CI [45.8-71.6]) in the ultra-high-density group vs. 40.9% (95% CI [30.3-55.3]) in the conventional mapping group (P=0.043). Around 24 months after the initial ablation the difference in recurrences of ventricular tachycardia between both groups diminished leading to converging Kaplan-Meier curves. The median recurrence-free survival time was 22.1 months (95% CI [8.9-NA]) in patients with ultra-high-density mapping vs. 5.1 months (95% CI [2.5-17.1]) in patients with conventional mapping.

Conclusion:
Ultra-high-density mapping guided catheter ablation in patients with ventricular tachycardia results in an improved 12-months outcome. However, this improved outcome might equalise during long-term follow-up. Randomised studies are needed to confirm these results.

Clin Res Cardiol (2021) DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Ultra-High-Density Mapping during Catheter Ablation of Ventricular Tachycardia – Is it Worth the Effort?
R. Schleberger¹, J. Schwarzl¹, J. Moser¹, M. Nies¹, A.-K. Kahle¹, A. Höller², S. Willems³, C. Meyer⁴
¹Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; ²Institute of Medical Biometry and Epidemiology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg; ³Kardiologie, Asklepios Klinik St. Georg, Hamburg; ⁴Klinik für Kardiologie, Evangelisches Krankenhaus Düsseldorf, Düsseldorf;
Background: Electro-anatomical ultra-high-density mapping depicts comprehensive information of the myocardial substrate and the arrhythmia mechanism. Whether this detailed insight translates into a better procedural outcome compared to a point-by-point mapping approach is not yet fully understood. Methods: We retrospectively compared the procedural parameters and long-term outcome of 122 consecutive patients whose ablation was either guided by ultra-high-density mapping using a 64-polar basket catheter (Intellamap OrionTM, Rhythmia HDxTM, Boston Scientific) or by conventional point-by-point 3D-mapping (Thermocool®, Carto®, Biosense Webster). Results: Patients with ultra-high-density mapping (age 64.9±12.7 years, 93.4% male, 60.7% ischemic cardiomyopathy) and patients with conventional point-by-point mapping (age 64.8±11.2 years, 91.8% male, 63.9% ischemic cardiomyopathy) had a similar acute procedural success rate (82.0% vs. 92.3%; P=0.145). The Kaplan-Meier estimate of recurrence-free survival at 12 months after ablation was 57.3% (95% CI [45.8-71.6]) in the ultra-high-density group vs. 40.9% (95% CI [30.3-55.3]) in the conventional mapping group (P=0.043). Around 24 months after the initial ablation the difference in recurrences of ventricular tachycardia between both groups diminished leading to converging Kaplan-Meier curves. The median recurrence-free survival time was 22.1 months (95% CI [8.9-NA]) in patients with ultra-high-density mapping vs. 5.1 months (95% CI [2.5-17.1]) in patients with conventional mapping. Conclusion: Ultra-high-density mapping guided catheter ablation in patients with ventricular tachycardia results in an improved 12-months outcome. However, this improved outcome might equalise during long-term follow-up. Randomised studies are needed to confirm these results.
https://dgk.org/kongress_programme/jt2021/aV1344.html