Adding 3D electroanatomical mapping to cryoballoon pulmonary vein isolation improves pulmonary vein isolation durability at repeat ablation procedure

The addition of pre- and post-ablation electroanatomical mapping with the Achieve catheter and EnSite mapping system has shown to improve acute pulmonary vein isolation (PVI) rate of cryoballoon ablation (CBA). Recently, our group also demonstrated an improvement in 1-year outcome. Current study aimed to investigate the impact on PVI durability as seen during repeat ablation procedure.

400 patients were compared in a propensity-matched analysis between CT- and Achieve catheter guided CBA (Control group; N=200) and Achieve catheter guided CBA with additional EnSite voltage maps performed pre- and post-CBA (Mapping group; N=200). Matching parameters were age, AF type and CHADS-VASc score. In patients undergoing repeat procedure, PV status was evaluated using CARTO mapping system.

Baseline characteristics did not differ between both groups (Persistent AF: 47,5% vs. 46,5%, P=0,841; diagnosis-to-ablation time: 28,1±15,1 vs. 33,2±41,7months, P=0,107). The mapping group had a shorter follow-up time (25,6±7,2 vs. 50,3±3,3months, P<0,001). Repeat ablation was performed in 20 patients in the mapping group and 70 patients in the control group. At repeat, the proportion of patients with persistent complete PVI was higher in the mapping group (14/20(70.0%) vs 23/70(32,9%), P=0,030). Interestingly, less reconnections of the right inferior PV were seen in the mapping group (10,0% vs. 34,3%, P=0,035). There was no difference in reconnection rate of other PVs.

The addition of electro-anatomical EnSite mapping to the Achieve catheter improves PVI durability as seen during repeat ablation, mainly at the level of the right inferior PV. This finding might explain the improvement in 1-year outcome of this approach.