Co-Author(s):
Martijn Klaver, MD - Cardiologist, St Antonius Hospital
Bob Abeln, MD - Cardiologist, St Antonius Hospital
Bakhtawar Mahmoodi, MD PhD - St Antonius Hospital
Vincent Van Dijk, MD PhD - Electrophysiologist, St Antonius Hospital
Maurits Wijffels, MD PhD - Electrophysiologist, St Antonius Hospital
Lucas Boersma, Professor - Electrophysiologist, St Antonius Hospital
St Antonius Hospital
Koekoekslaan 1 3425 CM Nieuwegein The Netherlands
Introduction | Objectives: High-density (HD) mapping of ablation targets may increase success. The purpose of the present study was to compare HD mapping with conventional mapping in ablation of AAFL.
Methods: We compared baseline and procedural characteristics, procedural success, safety and outcome of mapping and ablation of atypical flutter in three groups. (1) HD Grid catheter + the high-density electro anatomical mapping (EAM) system EnSite Precision (2) standard 10-pole circular mapping catheter (CMC) + Ensite Precision (3) CMC + the low density Ensite Velocity EAM.
Results: 82 patients were included. Mapping of 142 atypical atrial flutters was attempted. Acute ablation success was 78%, 68% and 51% in groups 1, 2 and 3 (p=0.037 between group 1 and 3, NS between groups otherwise). 8, 27 and 36% of flutters were unmappable in groups 1, 2, and 3, respectively (p< 0.05 between group 1 and both groups 2 and 3, respectively). AAFL recurrence at 1-year FU was 26%, 36% and 62% in groups 1, 2 and 3 (p=0.007 between group 1 and 3, p=0.05 between group 2 and 3). AAFL-free survival was significantly higher in patients mapped with Precision than with Velocity (p=0.011).  No serious adverse events occurred within 30 days.
Conclusions: Acute procedural success and freedom from recurrent AAFL at 1-year are significantly higher using the HD-Grid mapping catheter in combination with the high-density EnSite Precision system, as compared to a decapolar circular mapping catheter and the low-density EnSite Velocity EAM system. HD Mapping is safe.