ESC Journals
Research grant from Abbott
We have recently described a novel evaluation of AF voltage which correlates better with MRI-DE defined scar than sinus rhythm voltage. We evaluated the clinical efficacy of additional voltage-based substrate modification in the Persistent AF patient cohort in a single centre case series.
Methods
22 PsAF patients undergoing catheter ablation were recruited. Left atrial electroanatomical maps were created in AF before any ablation was performed in all patients. Mean peak to peak AF voltage mapping was undertaken using 8s segments of AF (<0.35mV). PVI was then performed in all patients after which, further ablation lesions were delivered on the underlying scar tissue (transection, box formation or homogenisation).
Of the 22 patients currently under follow up, 16 patients are more than 12 months after their initial procedure. 11/16 patients have had no recurrence and no patient is currently on anti-arrhythmic medication.
From our series, 69% of PsAF patients remain arrhythmia free at one year follow up post blanking period with a single procedure. Ablation of low voltage areas appears to infer incremental benefit in the Persistent AF population.
Table 1
Mean Age, yrs | 64 ± 9 | |
---|---|---|
Male | 19 (86.3) | |
Diabetes mellitus | 1 (4.5) | |
Hypertension | 7 (31.8) | |
TIA/CVA | 2 (9) | |
Left ventricular EF ≥55% | 22 (100.0) | |
LA size (diameter, according to British Society of Echocardiography Guidelines) | ||
Normal -Mild | 12 (54.5) | |
Moderate - Severe | 10 (45.5) | |
Mean AF duration, months | 24.2 ± 20.8 | |
Current antiarrhythmic strategy | ||
Amiodarone | 3 (13.6) | |
Sotalol | 1 (4.5) | |
Current anticoagulation | ||
Warfarin | 3 (13.6) | |
Direct oral anticoagulants | 19 (86.3) | |
Values are mean ± SD or N (%) or duration in months ± SD AF = atrial fibrillation; CVA= cerebrovascular accident; EF = ejection fraction; LA = left atrium; TIA = transient ischaemic attack. |
Baseline characteristics of patients (n = 22)
Abstract Figure. Ablation sets and AF Voltage