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

Chin Yu Lin, Abigail Louise D. Te, Yenn Jiang Lin, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Fa Po Chung, Ta Chuan Tuan, Tze Fan Chao, Jo Nan Liao, Ting Yung Chang, Shinya Yamada, Vu Van Ba, Simon Salim, Jennifer Jeanne B. Vicera, Ting Chun Huang, Cheng I. Wu, Chih Min Liu, Shih Ann Chen

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Abstract

Background: 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. Methods: 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. Results: 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). Conclusion: 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.

Original languageEnglish
Pages (from-to)90-96
Number of pages7
JournalInternational Journal of Cardiology
Volume272
DOIs
Publication statusPublished - 2018 Dec 1

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Lin, C. Y., Te, A. L. D., Lin, Y. J., Chang, S. L., Lo, L. W., Hu, Y. F., Chung, F. P., Tuan, T. C., Chao, T. F., Liao, J. N., Chang, T. Y., Yamada, S., Van Ba, V., Salim, S., Vicera, J. J. B., Huang, T. C., Wu, C. I., Liu, C. M., & Chen, S. A. (2018). High-resolution mapping of pulmonary vein potentials improved the successful pulmonary vein isolation using small electrodes and inter-electrode spacing catheter. International Journal of Cardiology, 272, 90-96. https://doi.org/10.1016/j.ijcard.2018.06.062