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Abstract 15553: The Long-term Outcome Beyond Pulmonary Vein Isolation of Ablation Guided by the Online and Real-time Atrial Fibrillation Imaging System: Extra Mapping Project


 Introduction:
 Although modulation of atrial fibrillation (AF) drivers and/or substrates has been proposed as one of the effective ablation strategies for non-paroxysmal AF (Non-PAF), previous meta-analyses showed that ablation, targeting complex fractionated atrial electrogram (CFAE) indirectly-reflecting Non-PAF drivers, had no additional benefit for post-pulmonary vein isolation (PVI) Non-PAF. As an alternative ablation strategy for Non-PAF, rotor ablation has been proposed as one of the potentiated ablation strategies for Non-PAF. However, the optimal ablation strategy is still unclear because reliable method detecting AF drivers remain unsettled in clinical practice.
 
 
 Hypothesis:
 Because rotors are known as key mechanisms for Non-PAF, we might open the possibility of Non-PAF control by the real-time visualization of wave dynamics during AF ablation.
 
 
 Methods:
 Consecutive 140 Non-PAF patients were enrolled in this study. The clinically-available online and real-time AF imaging system with high-spatiotemporal density (ExTRa Mapping
 TM
 ) developed by our group was applied in case Non-PAF was remained after PVI. Then, we detected and ablated non-passively-activated areas where rotational activations in the form of meandering rotors and/or multiple wavelets assumed to contain Non-PAF drivers were frequently observed (figure, top). The recurrence rate of Non-PAF or atrial tachycardia (AT) after the ablation was compared to that in patients underwent PVI-alone at our hospital.
 
 
 Results:
 The propensity scores selected each 34 people from ExTRa-strategy group and PVI-alone group (figure, middle). The 24-month freedom ratio from Non-PAF/AT in the matched-ExTRa-strategy group was higher than the matched-PVI-alone group, which was close to significance (p = 0.056) (figure, bottom).
 
 
 Conclusion:
 The ExTRa Mapping-guided ablation for PVI-refractory Non-PAF might be superior to PVI-alone.
 
 
 
