Acute and long-term ablation results of extra pulmonary vein drivers detected by ultra high density mapping on top of PVI in persistent AF

Background Whether ultra-high density (UHD) contact mapping is useful in radiofrequency ablation of persistent atrial fibrillation (AF) is unknown. Objective To sequentially map the left atrial (LA) activation during AF ablation (circumferential PVI and ablation of extra pulmonary vein drivers). Methods Time reference was an LA appendage (LAA) electrogram (EGM). Points were acquired with respiratory gating if reference, cycle length (10 ms tolerance) and electrode location were stable. For fragmented EGM the timing of the surrounding area was used. In case of extremely low voltage ( Fig. 1 ). All pts had PVI followed by remapping and ablation of the centre of rotational regions and at sites with focal type propagation. DC or chemical cardioversion were not performed in the first 48 h. Results Out of 41 patients (pts) undergoing first time ablation with the above described protocol, 30 (66 ± 8 y, mean current episode duration 8 months) were followed for a mean time of 14,7 months. At 48 hours post-procedure, 70% of pts were no longer in AF: 6 (20%) in sinus rhythm and 15 (50%) in atrial tachycardias. At 1 year after a single procedure, freedom from AF was 87% and freedom from AF and AT was 60% ( Fig. 1 ). Conclusion In persistent AF, sequential UHD activation mapping is useful in guiding and potentially improving long-term results of ablation of extra pulmonary vein drivers after PVI.