St. Antonius Hospital Nieuwegein, Koekoekslaan 1, 3435, CM, Nieuwegein, The Netherlands.
J Interv Card Electrophysiol. 2021 Dec;62(3):587-599. doi: 10.1007/s10840-021-00939-7. Epub 2021 Jan 17.
Ablation of atypical atrial flutter (AAFL) can be challenging. High-density (HD) mapping of ablation targets may potentially increase procedural success and freedom from recurrent AAFL. The objective of the present study was to explore whether employing HD mapping leads to a more favorable outcome in ablation of AAFL.
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 electroanatomical mapping (EAM) system EnSite Precision; (2) standard 10-pole circular mapping catheter (CMC) + EnSite Precision; (3) CMC + the low-density EnSite Velocity EAM. Voltage and propagation maps were constructed.
Mapping of 142 AAFL in 82 patients was performed. Acute ablation success was 78%, 68%, and 51% in groups 1, 2, and 3 (p = 0.037 between group 1 and 3, non-significant between groups otherwise). Moreover, 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). AAFL recurrence at 1-year FU was 26%, 36%, and 62% in groups 1, 2, and 3 (p = 0.007 between groups 1 and 3, p = 0.05 between groups 2 and 3). AAFL-free survival was significantly higher in patients mapped with Precision than with Velocity (p = 0.011). No strokes or mortality occurred within 30 days.
Acute procedural success of ablation of atypical atrial flutter is higher and the number of unmappable flutters is lower 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. This may lead to increased freedom from recurrent AAFL at 1 year. HD mapping is safe.
消融非典型性房性心动过速（AAFL）具有一定挑战性。高密度（HD）标测消融靶点可能会提高手术成功率和防止 AAFL 复发。本研究旨在探讨使用 HD 标测是否会提高 AAFL 消融的效果。
我们比较了三组患者的基线和手术特征、手术成功率、安全性以及标测和消融的结果。（1）HD 栅格导管+高密度电生理标测系统 EnSite Precision；（2）标准 10 极环形标测导管（CMC）+EnSite Precision；（3）CMC+低密度 EnSite Velocity 电生理标测系统。构建电压和传播图。
82 例患者共进行了 142 例 AAFL 的标测和消融。第 1、2、3 组的即刻消融成功率分别为 78%、68%和 51%（第 1 组与第 3 组比较，p = 0.037；其余组间比较差异无统计学意义）。此外，第 1、2、3 组分别有 8%、27%和 36%的 AAFL 无法标测（第 1 组与第 2、3 组比较，p < 0.05）。第 1、2、3 组的 1 年随访时 AAFL 复发率分别为 26%、36%和 62%（第 1 组与第 3 组比较，p = 0.007；第 2 组与第 3 组比较，p = 0.05）。使用 EnSite Precision 系统的高密度标测与使用 EnSite Velocity 系统的低密度标测相比，AAFL 无复发的生存概率更高（p = 0.011）。30 天内无卒中或死亡发生。
与使用 10 极环形标测导管和低密度 EnSite Velocity 电生理标测系统相比，HD 栅格导管联合高密度 EnSite Precision 系统进行 AAFL 消融时，即刻手术成功率更高，无法标测的 AAFL 更少。这可能会提高 1 年时 AAFL 无复发的概率。HD 标测是安全的。
