Author + information
- Andrew Williams,
- Zeshan Ahmad and
- Wilber Su
Introduction: Ablation of persistent and long-standing persistent atrial fibrillation (AF) is challenging. A common approach begins with pulmonary vein isolation (PVI), however when PVI fails the next step is not well defined. Physiologic mapping, such as the Topera system, has been successfully used in AF ablations prior to PVI. We hypothesized use of Topera rotor mapping may be successful in eliminating AF in patients who have had recurrence despite PVI.
Methods: The results of Topera guided rotor ablation from 14 patients (age 67 ± 8 years; LA Size 60 ± 9 mm; RA size 70 ± 12 mm) with recurrent AF following PVI were reviewed. 10 patients had long-standing persistent AF; 4 had persistent AF. Each patient had previously undergone prior PVI using cryoballoon ablation and later had recurrence of AF. At the time of Topera mapping, pulmonary veins were confirmed to remain isolated. Topera was then used to identify physiologic rotors for ablation using irrigated radiofrequency (RF).
Results: Upon initial confirmation of PVI, 1 of 14 patients (7%) was noted to have pulmonary vein reconnection, and underwent focal touch-up RF ablation to achieve PVI. Using Topera mapping, all patients were noted to have AF sources; an average of 3 ± 1.2 rotors were identified per case. In 2 of 14 patients (14%), rotors were identified near the atrial septum and were not ablated. In the remainder of cases (12 of 14, 86%) all identified rotors were ablated using irrigated RF. 0 cases of spontaneous termination of AF was seen post rotor ablation. Topera mapping was then used to confirm rotor elimination post ablation. Of the 14 patients who underwent rotor ablation, only 2 of the 14 (14%) were noted to have successful resolution of AF over 3 months of follow-up.
Conclusions: Rotor-guided AF ablation in this post-PVI cohort of patients has shown to have limited success in eliminating recurrent AF. This may be related to complexities of AF physiology that are not completely characterized by the Topera system, specifically in situations where the physiologic substrate has been altered by prior PVI. A larger cohort of patient will be needed to delineate the effectiveness and added value of rotor mapping in the post-PVI recurrent AF population.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias and Clinical EP: AF Ablation
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1150-092
- 2017 American College of Cardiology Foundation