Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

D-PO02-126 - Prospective Star Guided Ablation In Persistent Af Using Sequential Mapping With Multipolar Catheter (ID 217)

  S. Honarbakhsh: Ownership/Partnership/Principal - Rhythm AI Ltd.


Background: The Stochastic Trajectory Analysis of Ranked signals (STAR) mapping system is able to guide radiofequency (RF) ablation of persistent AF drivers (AFD), using data acquired from a basket catheter.
Objective: Examine results using sequentially acquired data from any 3D mapping system.
Methods: Following pulmonary vein isolation (PVI) of persistent AF patients (pts); >10 widely spaced left atrial (LA) recordings were made of AF (for >30s) using PentaRay, Orion or HD-grid catheters (CARTO, Rhythmia or Precision). Data were processed in real-time by the STAR mapping system to identify AFDs on a replica of the 3D system geometry. RF ablation was performed at the corresponding sites on the 3D system geometry. An study-defined ablation response included AF termination or CL slowing of ≥30ms. AF/atrial tachycardia (AT) recurrence was assessed using Holter monitoring during follow-up.
Results: Of 22 pts (61.3±8.1 yrs with 13.6±4.5 months AF duration), 2 terminated to sinus rhythm (SR) with PVI. Thus 20 had STAR-guided RFA of 57 AFDs (3.3±1.8 per pt) with an ablation response seen with 72% of these (16 AF termination and 25 CL slowing). AF terminated as a result of ablation in 80% of pts (10 to AT and 6 to SR) with 2.8±0.9 minutes of RF. During follow-up (15.3±7.6 months), 17 (85%) pts were AF/AT free. Fig 1- Ai-ii- STAR map with AFD on anterior/roof. Bi-ii- Rhythmia map showing RFA sites. C- Bard signals showing i) AF→AT 1st RF and ii) SR with further RF.
Conclusion: STAR-guided AFD ablation using data from standard 3D mapping technologies results in AF termination in 80% of persistent AF pts with 2.8 minutes of RF and 85% freedom from AF/AT during follow-up off anti-arrhythmic drugs.