High-resolution mapping of pulmonary vein potentials improved the successful pulmonary vein isolation using small electrodes and inter-electrode spacing catheter

• Published in: International journal of cardiology Vol. 272; pp. 90 - 96
• Main Authors: Lin, Chin-Yu, Te, Abigail Louise D., Lin, Yenn-Jiang, Chang, Shih-Lin, Lo, Li-Wei, Hu, Yu-Feng, Chung, Fa-Po, Tuan, Ta-Chuan, Chao, Tze-Fan, Liao, Jo-Nan, Chang, Ting-Yung, Yamada, Shinya, Van Ba, Vu, Salim, Simon, Vicera, Jennifer Jeanne B., Huang, Ting-Chun, Wu, Cheng-I, Liu, Chih-Min, Chen, Shih-Ann
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.12.2018
• Subjects: Aged; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - surgery; Catheter Ablation - instrumentation; Catheter Ablation - methods; Computed Tomography Angiography - instrumentation; Computed Tomography Angiography - methods; Electrocardiography - instrumentation; Electrocardiography - methods; Electrophysiologic Techniques, Cardiac - instrumentation; Electrophysiologic Techniques, Cardiac - methods; Female; High-resolution mapping; Humans; Inter-electrode spacing; Male; Microelectrodes; Middle Aged; Multielectrode catheter; Prospective Studies; Pulmonary vein potential; Pulmonary Veins - diagnostic imaging; Pulmonary Veins - surgery; RSPV; SVC; PVI; AF; PV; ECG; Inter-electrode spacing; 3-D; LSPV; Pulmonary vein potential; LA-PV; LA; Multielectrode catheter; High-resolution mapping
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2018.06.062

Intracardiac electrogram recording is influenced by the electrode size and inter-electrode spacing. Smaller electrodes with a closer inter-electrode spacing may improve the mapping resolution and outcome. Substrate mapping of the left atrium and residual pulmonary vein (PV) potentials during sinus rhythm was sequentially performed using a 3.5-mm electrode tip catheter and a 1-mm electrode multielectrode catheter in 33 patients (Group 1) that underwent repeat atrial fibrillation (AF) procedures. PV gap identification and electrophysiological characteristics were compared. Arrhythmia freedom was compared with a propensity matched (1:2) control group (66 patients, Group 2) undergoing repeat AF procedures guided by wide inter-electrode spacing catheter. In the Group 1 patients, the total area of residual PV potentials measured using the 1-mm catheter was larger than that measured by the 3.5-mm catheter. Overall 1.97 ± 0.59 (1–3) and 1.49 ± 0.62 (1–3) PVs were identified by the 1-mm electrode and 3.5 mm catheters, respectively (P = 0.02). The gaps not identified by the 3.5 mm catheter had a smaller width and lower voltage. Radiofrequency catheter ablation in the areas with residual PV potentials identified by the 1-mm catheter resulted in complete electrical isolation of the PVs. Arrhythmia freedom at one year of follow-up was achieved in 26 of 33 (78.8%) patients in Group 1, which was significantly higher than the matched control group (33/66 [50%], P < 0.05). In the patients with a previous PV isolation, mapping with small, closely spaced electrodes can increase the detection rate of residual PV potentials and improve the outcome. •Smaller electrodes with a closer inter-electrode spacing catheter improve mapping resolution and gap identification.•The gaps, which could not be identified by the bigger electrode catheter, were narrower and had a lower voltage.•High-resolution mapping improved outcome of repeat atrial fibrillation ablation.