Background Catheter ablation of persistent atrial fibrillation (PsAF) represents a challenge for the electrophysiologist and there are still divergences regarding the best ablative approach to adopt. Create a new map of the duration of atrial bipolar electrograms (Atrial Electrogram DUration Map, AEDUM) to recognize a functional substrate during sinus rhythm and guide a patient-tailored ablative strategy for PsAF. Methods Forty PsAF subjects were assigned in a 1:1 ratio to either for PVI alone (Group B1) or PVI+AEDUM areas ablation (Group B2). A cohort of 15 patients without AF history undergoing left-sided accessory pathway ablation was used as a control group (Group A). In all patients, voltage and AEDUM maps were created during sinus rhythm. The minimum follow-up was 12 months, with rhythm monitoring via 48-h ECG Holter or by implantable cardiac device. Results Electrogram (EGM) duration was higher in Group B than in Group A (49±16.2ms vs 34.2±3.8ms; p-value<0.001). In Group B the mean cumulative AEDUM area was 21.8±8.2cm2; no difference between the two subgroups was observed (22.3±9.1cm2 vs 21.2±7.2cm2; p-value=0.45). The overall bipolar voltage recorded inside the AEDUM areas was lower than in the remaining atrial areas [median: 1.30mV (IQR: 0.71–2.38mV) vs 1.54mV (IQR: 0.79–2.97mV); p-value: <0.001)]. Low voltage areas (<0.5mV) were recorded in three (7.5%) patients in Group B. During the follow-up [median 511 days (376–845days)] patients who underwent PVI-only experienced more AF recurrence than those receiving a tailored approach (65% vs 35%; p-value= 0.04). Conclusions All PsAF patients exhibited AEDUM

Ablation of persistent atrial fibrillation based on atrial electrogram duration map. methodology and clinical outcomes from the AEDUM pilot study / Rossi, Pietro; Cauti, FILIPPO MARIA; arco Polselli, M; · Marta Niscola, Michele Magnocavallo; Fanti, Veronica; Limite, LUCA ROSARIO; Evangelista, Antonietta; Bellisario, Alessandro; De Paolis, Ruggero; Facchetti, Simone; Quaglione, Raffaele; Piccirillo, Gianfranco; Bianchi, Stefano. - In: JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY. - ISSN 1572-8595. - (2024). [10.1007/s10840-023-01721-7]

Ablation of persistent atrial fibrillation based on atrial electrogram duration map. methodology and clinical outcomes from the AEDUM pilot study

Filippo Maria Cauti
Investigation
;
Luca Rosario Limite
Investigation
;
Antonietta Evangelista
Investigation
;
Raffaele Quaglione
Investigation
;
Gianfranco Piccirillo
Investigation
;
2024

Abstract

Background Catheter ablation of persistent atrial fibrillation (PsAF) represents a challenge for the electrophysiologist and there are still divergences regarding the best ablative approach to adopt. Create a new map of the duration of atrial bipolar electrograms (Atrial Electrogram DUration Map, AEDUM) to recognize a functional substrate during sinus rhythm and guide a patient-tailored ablative strategy for PsAF. Methods Forty PsAF subjects were assigned in a 1:1 ratio to either for PVI alone (Group B1) or PVI+AEDUM areas ablation (Group B2). A cohort of 15 patients without AF history undergoing left-sided accessory pathway ablation was used as a control group (Group A). In all patients, voltage and AEDUM maps were created during sinus rhythm. The minimum follow-up was 12 months, with rhythm monitoring via 48-h ECG Holter or by implantable cardiac device. Results Electrogram (EGM) duration was higher in Group B than in Group A (49±16.2ms vs 34.2±3.8ms; p-value<0.001). In Group B the mean cumulative AEDUM area was 21.8±8.2cm2; no difference between the two subgroups was observed (22.3±9.1cm2 vs 21.2±7.2cm2; p-value=0.45). The overall bipolar voltage recorded inside the AEDUM areas was lower than in the remaining atrial areas [median: 1.30mV (IQR: 0.71–2.38mV) vs 1.54mV (IQR: 0.79–2.97mV); p-value: <0.001)]. Low voltage areas (<0.5mV) were recorded in three (7.5%) patients in Group B. During the follow-up [median 511 days (376–845days)] patients who underwent PVI-only experienced more AF recurrence than those receiving a tailored approach (65% vs 35%; p-value= 0.04). Conclusions All PsAF patients exhibited AEDUM
2024
atrial fibrillation; catheter ablation; AEDUM; persistent atrial fibrillation; pulmonary vein isolation
01 Pubblicazione su rivista::01a Articolo in rivista
Ablation of persistent atrial fibrillation based on atrial electrogram duration map. methodology and clinical outcomes from the AEDUM pilot study / Rossi, Pietro; Cauti, FILIPPO MARIA; arco Polselli, M; · Marta Niscola, Michele Magnocavallo; Fanti, Veronica; Limite, LUCA ROSARIO; Evangelista, Antonietta; Bellisario, Alessandro; De Paolis, Ruggero; Facchetti, Simone; Quaglione, Raffaele; Piccirillo, Gianfranco; Bianchi, Stefano. - In: JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY. - ISSN 1572-8595. - (2024). [10.1007/s10840-023-01721-7]
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